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Mbakwe PL, Roine I, Cruzeiro ML, Kallio M, Peltola H, Pelkonen T. Clinical Picture and Risk Factors for Poor Outcome in Streptococcus pneumoniae Meningitis of Childhood on Three Continents. Pediatr Infect Dis J 2024; 43:415-419. [PMID: 38359336 PMCID: PMC11003404 DOI: 10.1097/inf.0000000000004265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Streptococcus pneumoniae meningitis (SpM) remains a major health burden worldwide, particularly in low- and middle-income countries. Identifying the patients at highest risk for mortality and disabling sequelae may reveal potentially avoidable predisposing factors and identify patients most in need of intensive care. We searched for factors that do not require laboratory facilities. METHODS This study was a secondary analysis of prospectively collected data from 5 clinical trials of childhood bacterial meningitis on 3 continents between 1984 and 2017. SpM cases were analyzed by study site and predictors for poor outcome (death or severe sequelae) were identified from the whole series, Latin America and Angola. RESULTS Among a total of 1575 children (age range: 2 months to 15 years), 505 cases were due to pneumococci. Compared to other etiologies, SpM doubled the death rate (33% vs. 17%) and tripled poor outcome (15% vs. 6%). In SpM, Glasgow Coma Score <13 [odds ratio (OR): 4.73] and previous antibiotics in Angola (OR: 1.70) were independent predictors for death. Predictors for poor outcome were age <1 year (OR: 2.41) and Glasgow Coma Score <13 (OR: 6.39) in the whole series, seizures in Latin America (OR: 3.98) and previous antibiotics in Angola (OR: 1.91). Angolan children had a 17-fold increased risk for poor outcome when compared with Finnish children ( P = 0.011). CONCLUSIONS Our study proved the severity of SpM when compared with other etiologies. The outcome was especially poor in Angola. Most patients at risk for poor outcome are easily identified by clinical factors on admission.
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Affiliation(s)
| | - Irmeli Roine
- Faculty of Medicine, University Diego Portales, Santiago, Chile
| | | | - Markku Kallio
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heikki Peltola
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuula Pelkonen
- Serviço de Neuroinfecciologia, Hospital Pediátrico David Bernardino, Luanda, Angola
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- New Children’s Hospital, Pediatric Research Center, Helsinki, Finland
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Shirazinia M, Sheybani F, Naderi H, Haddad M, Hajipour P, Khoroushi F. Chronic meningitis in adults: a comparison between neurotuberculosis and neurobrucellosis. BMC Infect Dis 2024; 24:441. [PMID: 38664652 DOI: 10.1186/s12879-024-09345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND In regions endemic for tuberculosis and brucellosis, distinguishing between tuberculous meningitis (TBM) and brucella meningitis (BM) poses a substantial challenge. This study investigates the clinical and paraclinical characteristics of patients with TBM and BM. METHODS Adult patients diagnosed with either TBM or BM who were admitted to two referral hospitals between March 2015 and October 2022, were included, and the characteristics of the patients were analyzed. RESULTS Seventy patients formed the study group, 28 with TBM and 42 with BM, were included. TBM patients had a 2.06-fold (95% CI: 1.26 to 3.37, P-value: 0.003) higher risk of altered consciousness and a 4.80-fold (95% CI: 1.98 to 11.61, P-value: < 0.001) higher risk of extra-neural involvement as compared to BM patients. Cerebrospinal fluid (CSF) analysis revealed a significantly higher percentage of polymorphonuclear leukocytes (PMN) in TBM compared to BM (Standardized mean difference: 0.69, 95% CI: 0.18 to 1.20, P-value: 0.008). Neuroimaging findings indicated higher risks of hydrocephalus (P-value: 0.002), infarction (P-value: 0.029), and meningeal enhancement (P-value: 0.012) in TBM compared to BM. Moreover, TBM patients had a 67% (95% CI: 21% to 131%, P-value:0.002) longer median length of hospital stay and a significantly higher risk of unfavorable outcomes (Risk ratio: 6.96, 95% CI: 2.65 to 18.26, p < 0.001). CONCLUSIONS Our study emphasizes that TBM patients displayed increased frequencies of altered consciousness, PMN dominance in CSF, extra-neural involvement, hydrocephalus, meningeal enhancement, and brain infarction. The findings emphasize the diagnostic difficulties and underscore the importance of cautious differentiation between these two conditions to guide appropriate treatment strategies.
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Affiliation(s)
- Matin Shirazinia
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereshte Sheybani
- Department of Infectious Diseases and Tropical Medicine, Imam Reza Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Daneshgah Street, Mashhad, Iran.
| | - HamidReza Naderi
- Department of Infectious Diseases and Tropical Medicine, Imam Reza Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Daneshgah Street, Mashhad, Iran
| | - Mahboubeh Haddad
- Department of Infectious Diseases and Tropical Medicine, Imam Reza Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Daneshgah Street, Mashhad, Iran
| | - Pouria Hajipour
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzaneh Khoroushi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Rashid M, Das SN, Hasan MM, Hera MFH, Rana MM, Saha R. Frequency of Hyponatremia in Adults with Acute Bacterial Meningitis. Mymensingh Med J 2024; 33:360-364. [PMID: 38557511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Bacterial meningitis is a life-threatening disease. Bacterial meningitis patients are prone to develop acute hyponatremia. In the central nervous system infection hyponatremia could be due to the Syndrome of Inappropriate Anti Diuretic Hormone secretion. The frequency of hyponatremia in adults with acute bacterial meningitis patients was seen in this study. This cross-sectional study was conducted in the Internal Medicine Department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from February 2016 to July 2016. A total of 50 patients were enrolled in this study by purposive sampling. Among 50 acute bacterial meningitis patients, 33 (66%) were diagnosed as hyponatremic state. The mean serum sodium level of 33 hyponatremic bacterial meningitis cases was 130.66±2.95 mmol/L. Most of the cases (78.79%) were mild hyponatremic state (130 mmol/L-135 mmol/L) whereas 18.18% were revealed as moderate hyponatremia (125 mmol/L-129 mmol/L). Only 3.03% of cases were presented as severe cases (≤124 mmol/L). The result revealed that a large number of patients with acute bacterial meningitis were suffering from hyponatremia and in the majority of cases were mildly hyponatremic.
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Affiliation(s)
- M Rashid
- Dr Mamunoor Rashid, Indoor Medical Officer, Department of Medicine, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail:
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Pelkonen T, Roine I, Cruzeiro ML, Kallio M, Peltola H. Pneumonia in childhood bacterial meningitis-Experience from three continents. Trop Med Int Health 2024; 29:319-326. [PMID: 38343008 DOI: 10.1111/tmi.13976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Although concomitant pneumonia is sometimes diagnosed in childhood bacterial meningitis, its role in the illness course and prognosis is not known. We examined these associations using prospectively collected data from Finland, Latin America and Angola. METHODS This was a secondary descriptive analysis of prospectively collected data (clinical and laboratory findings at admission, during hospitalisation and outcome) from five clinical bacterial meningitis trials. We included children aged 2 months to 15 years from sites with confirmed bacterial meningitis and potential concomitant pneumonia (diagnosed clinically with or without a chest radiograph). RESULTS Pneumonia was not observed in the 341 children included in Finland. Pneumonia was observed in 8% (51/606) of children in Latin America and in 46% (377/819) in Angola (p < 0.0001). In multivariate analyses, predisposing factors for pneumonia in Latin America were age <1 year, seizures and severe anaemia; the corresponding factors for Angola were preadmission duration of illness >3 days and non-meningococcal meningitis. Concomitant pneumonia increased the severity of the disease and disabling sequelae. CONCLUSION Bacterial meningitis with pneumonia is a major, previously undescribed entity of severe bacterial meningitis, especially in Angola.
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Affiliation(s)
- Tuula Pelkonen
- Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- New Children's Hospital, Pediatric Research Center, Helsinki, Finland
- Hospital Pediátrico David Bernardino, Luanda, Angola
| | - Irmeli Roine
- Faculty of Medicine, University Diego Portales, Santiago, Chile
| | | | - Markku Kallio
- Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heikki Peltola
- Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Rynkevič G, Žilinskas E, Streckytė D, Radzišauskienė D, Mameniškienė R. Etiology, Clinical Presentation, and Outcomes of Bacterial Meningitis in Adult Patients: A Retrospective Study in Lithuania (2018-2021). Med Sci Monit 2024; 30:e942904. [PMID: 38520034 DOI: 10.12659/msm.942904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Bacterial meningitis is a serious and life-threatening condition that requires prompt diagnosis and treatment. This retrospective study aimed to identify causes, presentation, and predictive factors for outcomes of community-acquired bacterial meningitis in 86 adults in Vilnius, Lithuania between 2018 and 2021. MATERIAL AND METHODS We performed a retrospective study of demographic, clinical, and laboratory records of 86 adult patients admitted to Vilnius University Hospital Santaros Clinics with a diagnosis of acute bacterial meningitis during the period of 2018-2021. RESULTS Of 86 patients, 54 (62.79%) were men. The median (Md) age of patients was 58 (range, 18-83) years and the median duration of hospitalization was 20 (range, 3-92) days. Patients were first hospitalized in the Intensive Care Unit (ICU) in 59.3% of cases. The most prevalent concerns were headache (66.28%), febrile temperature (56.98%), general fatigue (53.49%), and confusion/sleepiness (52.33%). Of 57 (66.28%) etiologically confirmed cases, the most prevalent agent was Listeria monocytogenes (29.82%), followed by Streptococcus pneumoniae (28.07%) and Neisseria meningitidis (28.07%). Patients with meningitis caused by L. monocytogenes were the oldest (P=0.003) and had the longest hospitalization (P<0.001). Fatigue was the prominent symptom in patients with meningococcal meningitis (81.2%, P=0.010). Twelve patients (13.95%) have died. Advanced age and low (<100 cells per μL) white blood cell (WBC) count in cerebrospinal fluid (CSF) were associated with lethal outcome, whereas headache was associated with favorable outcome. CONCLUSIONS Clinical characteristics of community-acquired acute bacterial meningitis differ based on etiological factors. Patient age, CSF WBC count, and headache may be significant predictive factors for outcomes of bacterial meningitis.
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Affiliation(s)
- Greta Rynkevič
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | - Daiva Radzišauskienė
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius, Lithuania
| | - Rūta Mameniškienė
- Clinic of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius, Lithuania
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Adawe DH, Mengistie DT. Determine the factors affecting the time to recovery of children with bacterial meningitis at Jigjiga university referral hospital in the Somali Regional State of Ethiopia: using the parametric shared frailty and AFT models. BMC Res Notes 2024; 17:85. [PMID: 38504305 PMCID: PMC10953244 DOI: 10.1186/s13104-024-06740-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/08/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Neisseria meningitides, Streptococcus pneumonia, and hemophilic influenza type B are frequently linked to bacterial meningitis (BM) in children. It's an infectious sickness that kills and severely mobilizes children. For a variety of reasons, bacterial meningitis remains a global public health concern; most cases and deaths are found in Sub-Saharan Africa, particularly in Ethiopia. Even though vaccination has made BM more preventable, children worldwide are still severely harmed by this serious illness. Age, sex, and co-morbidity are among the risk variables for BM that have been found. Therefore, the main objective of this study was to identify the variables influencing the time to recovery for children with bacterial meningitis at Jigjiga University referral hospital in the Somali regional state of Ethiopia. METHOD A retrospective cohort of 535 children with bacterial meningitis who received antibiotic treatment was the subject of this study. Parametric Shared Frailty ty and the AFT model were employed with log likelihood, BIC, and AIC methods of model selection. The frailty models all employed the patients' kebele as a clustering factor. RESULTS The number of cases of BM declined in young children during the duration of the 2 year, 11 month study period, but not in the elderly. Streptococcus pneumonia (50%), hemophilic influenza (30.5%), and Neisseria meningitides (15%) were the most frequent causes of BM. The time to recovery of patients from bacteria was significantly influenced by the covariates male patients (ϕ = 0.927; 95% CI (0.866, 0.984); p-value = 0.014), patients without a vaccination history (ϕ = 0.898; 95% CI (0.834, 0.965); P value = 0.0037), and patients who were not breastfeeding (ϕ = 0.616; 95% CI (0.404, 0.039); P-value = 0.024). The recovery times for male, non-breastfed children with bacterial patients are 7.9 and 48.4% shorter, respectively. In contrast to children with comorbidity, the recovery time for children without comorbidity increased by 8.7%. CONCLUSION Age group, sex, vaccination status, co-morbidity, breastfeeding, and medication regimen were the main determinant factors for the time to recovery of patients with bacterial meningitis. Patients with co-morbidities require the doctor at Jigjiga University Referral Hospital to pay close attention to them.
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Affiliation(s)
- Daud Hussein Adawe
- Department of Statistics, College of Natural and Computational Science, Jigjiga University, Jigjiga, Ethiopia
| | - Dagne Tesfaye Mengistie
- Department of Statistics, College of Natural and Computational Science, Jigjiga University, Jigjiga, Ethiopia.
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Mohialdin D, Abu-Farha R, ALkhawaldeh R, Zawiah M, Abu Hammour K. Audit of adherence to international guidelines (IDSA) in the treatment of infectious meningitis in pediatric patients in Jordan. Curr Med Res Opin 2024; 40:423-430. [PMID: 38308446 DOI: 10.1080/03007995.2024.2314738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/01/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE This study aims to audit the adherence of Jordanian medical care staff to the guidelines provided by the Infectious Disease Society of America (IDSA) for managing pediatric patients admitted with suspected cases of meningitis. METHODS A retrospective observational study was conducted at Jordan University Hospital (JUH). All pediatric patients admitted to JUH with suspected meningitis between January 1, 2019, and September 30, 2022, who underwent Cerebrospinal Fluid (CSF) and blood culture tests were recruited in this study unless there was a reason for exclusion. The study collected data on the empiric antibiotics prescribed prior to diagnostic cultures and susceptibility results. Additionally, the length of hospital stay and all-cause mortality were observed. The appropriateness of antibiotics prescription before culture results was compared to IDSA guidelines, and an overall adherence rate was calculated. RESULTS A total of 332 pediatric patients were included in this study, of whom 12.3% (n = 41) were diagnosed with bacterial meningitis. Among the enrolled pediatric patients, only 27 patients (8.1%) received appropriate treatment adhering to the IDSA guidelines. The remaining 91.9% (n = 305) showed various forms of non-adherence to recommendations. The highest adherence rate was observed for performing CSF culture (n = 330, 99.4%), while the lowest adherence rate was found in selecting the appropriate dose and duration for empiric antibiotics (n = 107, 41.3% and n = 133, 51.0%, respectively). CONCLUSION This study revealed a low overall adherence in the management of pediatric patients with meningitis in Jordan. Establishing an antimicrobial stewardship program may improve the outcomes of meningitis infections found in Jordan, and prevent dangerous adverse effects and bacterial resistance.
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Affiliation(s)
- Dina Mohialdin
- Clinical Pharmacy and Therapeutics Department, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Rana Abu-Farha
- Clinical Pharmacy and Therapeutics Department, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Rama ALkhawaldeh
- Clinical Pharmacy and Therapeutics Department, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Mohammed Zawiah
- Department of Clinical Pharmacy, College of Pharmacy, Northern Border University, Rafha, Saudi Arabia
| | - Khawla Abu Hammour
- Department of Clinical Pharmacy and Biopharmaceutics, Faculty of Pharmacy, University of Jordan, Amman, Jordan
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Sirijatuphat R, Rungrotsakhon A, Leelaporn A. Clinical characteristics and outcomes of acute bacterial meningitis in adults at a tertiary university hospital in Thailand. Medicine (Baltimore) 2024; 103:e37301. [PMID: 38394527 PMCID: PMC10883623 DOI: 10.1097/md.0000000000037301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
The epidemiology of acute bacterial meningitis varies among settings, areas, and times. This study aimed to determine the clinical characteristics, the causative organisms and their antibiotic susceptibility, and the outcomes of patients with acute bacterial meningitis in Thai adults. This retrospective study included hospitalized patients aged ≥18 years diagnosed with acute bacterial meningitis at Siriraj Hospital during January 2002-December 2016. Of 390 patients, the median age was 48 years, 51% were male, and 80% had at least 1 underlying illness. Over half (54%) of patients had community-acquired bacterial meningitis (CBM), and 46% had nosocomial bacterial meningitis (NBM). The triad of acute bacterial meningitis (fever, headache, and neck stiffness) was found in 46% of CBM and 15% of NBM (P < .001). The causative organisms were identified in about half (53%) of patients. Most study patients (73%) received antibiotic treatment before the CSF collection. Causative organisms were identified more frequently in CBM (P < .001). Gram-positive cocci were more prevalent in CBM (P < .001), whereas Gram-negative bacilli were more common in NBM (P < .001). Streptococcus agalactiae (29%), Streptococcus pneumoniae (12%), and Streptococcus suis (11%) were most common in CBM, and all of them were sensitive to third-generation cephalosporins. Acinetobacter baumannii (19%), Klebsiella pneumoniae (16%), and Staphylococcus aureus (11%) were the most common organisms in NBM, and antibiotic-resistant isolates were frequently found among these organisms. Ceftriaxone monotherapy and meropenem plus vancomycin were the most common empiric antibiotic in CBM and NBM, respectively. Mortality was 19% among CBM and 23% among NBM (P = .338). HIV infection, alcoholism, pneumonia, shock, and disseminated intravascular coagulation were independent predictors of mortality. Mortality remains high among adults with acute bacterial meningitis in Thailand. A clinical practice guideline for acute bacterial meningitis should be developed that is based on local epidemiology and microbiology data.
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Affiliation(s)
- Rujipas Sirijatuphat
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Attasit Rungrotsakhon
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Amornrut Leelaporn
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Niemelä S, Lempinen L, Löyttyniemi E, Grönroos JO, Luoto R, Peltola V, Jero J. Finnish paediatric study found a low incidence of bacterial meningitis from 2011 to 2018 but a substantial proportion of nosocomial meningitis. Acta Paediatr 2024; 113:327-335. [PMID: 37800382 DOI: 10.1111/apa.16991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
AIM This study examined the predisposing factors, clinical picture, bacterial aetiology and clinical outcomes of infants and children with bacterial meningitis (BM). METHODS The medical records of patients under 16 years of age, treated by Turku University Hospital, Finland, from 2011 to 2018, were screened for meningitis using the International Classification of Diseases, Tenth Revision codes. Patients were included if bacteria were detected in cerebrospinal fluid (CSF) or other predefined laboratory variables indicated BM, despite CSF testing negative for bacteria. The Glasgow Outcome Scale (GOS) was used to determine outcomes. RESULTS We identified 37 children with BM: 22 infants aged 0-89 days and 15 children aged 90 days to 15 years. The overall incidence was approximately 5.7/100 000/year. Nosocomial meningitis was documented in 51%. Bacterial growth was detected in the CSF or blood cultures of the majority of patients (57%). Escherichia coli (14%), group B streptococcus (11%) and Streptococcus pneumoniae (8%) were the most common pathogens. There were 14% of patients with unfavourable outcomes, namely GOS scores of 1-4, but no deaths. CONCLUSION The incidence of paediatric BM was low during the study period, but the proportion of nosocomial meningitis was substantial. The frequency of unfavourable long-term outcomes was relatively low.
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Affiliation(s)
- Sakke Niemelä
- Department of Otorhinolaryngology, Turku University Hospital, University of Turku, Turku, Finland
| | - Laura Lempinen
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, Turku University Hospital, University of Turku, Turku, Finland
| | - Juha O Grönroos
- Department of Clinical Microbiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Raakel Luoto
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Ville Peltola
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Jussi Jero
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Tondé I, Tranchot-Diallo J, Kambiré D, Ky-Ba A, Sanou M, Sanou I, Ouédraogo-Traoré R. Genomic and phenotypic diagnosis of bacterial meningitis in 25 health districts in Burkina Faso between January 2016 and December 2019. Infect Dis Now 2024; 54:104805. [PMID: 37827376 DOI: 10.1016/j.idnow.2023.104805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/16/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Issa Tondé
- Centre Hospitalier Universitaire Pédiatrique Charles De Gaulle, Burkina Faso; Université Joseph Ki-Zerbo, Burkina Faso.
| | - Juliette Tranchot-Diallo
- Centre Muraz, Institut National de Santé Publique (INSP), Burkina Faso; Université Nazi Boni, Burkina Faso
| | | | - Absatou Ky-Ba
- Université Joseph Ki-Zerbo, Burkina Faso; Centre Hospitalier Universitaire du District sanitaire de Bogodogo, Burkina Faso
| | - Mahamoudou Sanou
- Centre Hospitalier Universitaire Pédiatrique Charles De Gaulle, Burkina Faso; Université Joseph Ki-Zerbo, Burkina Faso
| | - Idrissa Sanou
- Université Joseph Ki-Zerbo, Burkina Faso; Centre Hospitalier Universitaire Tengandogo, Burkina Faso
| | - Rasmata Ouédraogo-Traoré
- Centre Hospitalier Universitaire Pédiatrique Charles De Gaulle, Burkina Faso; Université Joseph Ki-Zerbo, Burkina Faso
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Liu JJ, Xu ZW, Xu HQ, Zhu JJ, Zhang JN, Fang S, Yuan SF, Ge HJ, Li HJ, Lou WJ, Chen LH, Gao F, Chen YH. Diagnostic status and epidemiological characteristics of community-acquired bacterial meningitis in children from 2019 to 2020: a multicenter retrospective study. BMC Pediatr 2024; 24:11. [PMID: 38178076 PMCID: PMC10765892 DOI: 10.1186/s12887-023-04469-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
Community-acquired bacterial meningitis (CABM) is the main cause of morbidity and mortality in children. The epidemiology of CABM is regional and highly dynamic. To clarify the diagnostic status and epidemiological characteristics of children with CABM in this region, and pay attention to the disease burden, so as to provide evidence for the prevention and treatment of CABM. By retrospective case analysis, the clinical data of 918 CABM cases in children aged 0-14 years in Zhejiang Province from January, 2019 to December, 2020 were collected. The etiological diagnosis rate of CABM in children was 23.1%, the annual incidence rate 4.42-6.15/100,000, the annual mortality rate 0.06-0.09/100,000,the cure and improvement rate 94.4%, and the case fatality rate 1.4%. The total incidence of neuroimaging abnormalities was 20.6%. The median length of stay for CABM children was 20(16) days, with an average cost of 21,531(24,835) yuan. In addition, the incidence rate was decreased with age. Escherichia coli(E.coli) and group B Streptococcus agalactiae(GBS) were the principal pathogens in CABM infant<3 months(43.3%, 34.1%), and Streptococcus pneumoniae(S. pneumoniae) was the most common pathogen in children ≥ 3 months(33.9%). In conclusion, the annual incidence and mortality of CABM in children aged 0-14 years in Zhejiang Province are at intermediate and low level. The distribution of CABM incidence and pathogen spectrum are different in age; the incidence of abnormal neuroimaging is high; and the economic burden is heavy.
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Affiliation(s)
- Juan-Juan Liu
- Department of Infectious Diseases, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310051, Zhejiang, China
| | - Zhi-Wei Xu
- Department of Pediatric Infectious Disease, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China
| | - Hui-Qing Xu
- Department of Pediatrics, Ningbo Women and Children's Hospital, Ningbo, 315012, Zhejiang, China
| | - Jia-Jun Zhu
- Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
| | - Jie-Ning Zhang
- Department of Pediatrics, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, 314000, China
| | - Sheng Fang
- Taizhou Hospital of Zhejiang Province, Taizhou, 317000, Zhejiang, China
| | - Sheng-Fu Yuan
- Department of Pediatrics, Yuyao People's Hospital, Yuyao, 315400, Zhejiang, China
| | - He-Jia Ge
- Department of Pediatrics, The Second Hospital of Jiaxing, Jiaxing, 314000, Zhejiang, China
| | - Hai-Jing Li
- Department of Neonatal Intensive Care Unit, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, 312000, Zhejiang, China
| | - Wen-Ji Lou
- Department of Pediatrics, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, 321000, China
| | - Li-Hua Chen
- Department of Neonatology, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310051, Zhejiang, China
| | - Feng Gao
- Department of neurology, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310051, Zhejiang, China
| | - Ying-Hu Chen
- Department of Infectious Diseases, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310051, Zhejiang, China.
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Mohanty S, Johansson Kostenniemi U, Silfverdal SA, Salomonsson S, Iovino F, Sarpong EM, Bencina G, Bruze G. Increased Risk of Long-Term Disabilities Following Childhood Bacterial Meningitis in Sweden. JAMA Netw Open 2024; 7:e2352402. [PMID: 38241045 PMCID: PMC10799263 DOI: 10.1001/jamanetworkopen.2023.52402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/30/2023] [Indexed: 01/22/2024] Open
Abstract
Importance Few studies have examined the incidence of long-term disabilities due to bacterial meningitis in childhood with extended follow-up time and a nationwide cohort. Objective To describe the long-term risks of disabilities following a childhood diagnosis of bacterial meningitis in Sweden. Design, Setting, and Participants This nationwide retrospective registry-based cohort study included individuals diagnosed with bacterial meningitis (younger than 18 years) and general population controls matched (1:9) by age, sex, and place of residence. Data were retrieved from the Swedish National Patient Register from January 1, 1987, to December 31, 2021. Data were analyzed from July 13, 2022, to November 30, 2023. Exposure A diagnosis of bacterial meningitis in childhood recorded in the National Patient Register between 1987 and 2021. Main Outcomes and Measures Cumulative incidence of 7 disabilities (cognitive disabilities, seizures, hearing loss, motor function disorders, visual disturbances, behavioral and emotional disorders, and intracranial structural injuries) after bacterial meningitis in childhood. Results The cohort included 3623 individuals diagnosed with bacterial meningitis during childhood and 32 607 controls from the general population (median age at diagnosis, 1.5 [IQR, 0.4-6.2] years; 44.2% female and 55.8% male, median follow-up time, 23.7 [IQR, 12.2-30.4] years). Individuals diagnosed with bacterial meningitis had higher cumulative incidence of all 7 disabilities, and 1052 (29.0%) had at least 1 disability. The highest absolute risk of disabilities was found for behavioral and emotional disorders, hearing loss, and visual disturbances. The estimated adjusted hazard ratios (HRs) showed a significant increased relative risk for cases compared with controls for all 7 disabilities, with the largest adjusted HRs for intracranial structural injuries (26.04 [95% CI, 15.50-43.74]), hearing loss (7.90 [95% CI, 6.68-9.33]), and motor function disorders (4.65 [95% CI, 3.72-5.80]). The adjusted HRs for cognitive disabilities, seizures, hearing loss, and motor function disorders were significantly higher for Streptococcus pneumoniae infection (eg, 7.89 [95% CI, 5.18-12.02] for seizure) compared with Haemophilus influenzae infection (2.46 [95% CI, 1.63-3.70]) or Neisseria meningitidis infection (1.38 [95% CI, 0.65-2.93]). The adjusted HRs for cognitive disabilities, seizures, behavioral and emotional disorders, and intracranial structural injuries were significantly higher for children diagnosed with bacterial meningitis at an age below the median. Conclusions and Relevance The findings of this cohort study of individuals diagnosed with bacterial meningitis during childhood suggest that exposed individuals may have had an increased risk for long-term disabilities (particularly when diagnosed with pneumococcal meningitis or when diagnosed at a young age), highlighting the need to detect disabilities among surviving children.
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Affiliation(s)
- Salini Mohanty
- Center for Observational and Real-World Evidence (CORE), Merck & Co Inc, Rahway, New Jersey
| | | | | | | | - Federico Iovino
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eric M. Sarpong
- Real-World Data Analytics and Innovation, Merck & Co Inc, Rahway, New Jersey
| | | | - Gustaf Bruze
- Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
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Rybak A, Ouldali N, Varon E, Taha MK, Bonacorsi S, Béchet S, Angoulvant F, Cohen R, Levy C. Vaccine-preventable Pediatric Acute Bacterial Meningitis in France: A Time Series Analysis of a 19-Year Prospective National Surveillance Network. Pediatr Infect Dis J 2024; 43:74-83. [PMID: 38108805 PMCID: PMC10723767 DOI: 10.1097/inf.0000000000004134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND In France, vaccination has been implemented against Hi serotype b (Hib), pneumococcus with pneumococcal conjugate vaccines (PCV), and Neisseria meningitidis serogroup C (MenC). These interventions with different coverage and uptake have disrupted the epidemiology of vaccine-preventable acute bacterial meningitis (ABM). METHODS We analyzed data from a French prospective surveillance network of ABM in children ≤15 years old enrolled by 259 pediatric wards (estimated national coverage: 61%). From 2001 to 2020, the effect of vaccine implementation was estimated with segmented linear regression. RESULTS We analyzed 7,186 cases, mainly due to meningococcus (35.0%), pneumococcus (29.8%), and Hi (3.7%). MenC ABM incidence decreased (-0.12%/month, 95% CI: -0.17 to -0.07, P < 0.001) with no change for the overall meningococcal ABM when comparing the pre-MenC vaccination and the post-MenC vaccination trends. Despite a decreasing MenB ABM incidence without a vaccination program (-0.43%/month, 95% CI: -0.53 to -0.34, P < 0.001), 68.3% of meningococcal ABM involved MenB. No change in pneumococcal ABM incidence was observed after the PCV7 recommendation. By contrast, this incidence significantly decreased after the switch to PCV13 (-0.9%/month, 95% CI: -1.6 to -0.2%, P = 0.01). After May 2014, a rebound occurred (0.5%/month, 95% CI: 0.3-0.8%, P < 0.001), with 89.5% of non-PCV13 vaccine serotypes. Hib ABM incidence increased after June 2017. CONCLUSIONS PCV7 and MenC vaccine introduction in France, with slow vaccine uptake and low coverage, had no to little impact as compared to the switch from PCV7 to PCV13, which occurred when coverage was optimal. Our data suggest that MenB and next-generation PCVs could prevent a large part of the ABM incidence in France.
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Affiliation(s)
- Alexis Rybak
- From the ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, Ile-de-France, France
- ECEVE, Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables, UMR S-1123, INSERM, Université Paris Cité, Paris, Ile-de-France, France
- Department of Pediatric Emergency, Trousseau University Hospital, Sorbonne Université, Paris, Ile-de-France, France
| | - Naïm Ouldali
- From the ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, Ile-de-France, France
- Department of Pediatrics, Department Woman-Mother-Child, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), Lausanne, Vaud, Switzerland
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris Cité, Paris, Ile-de-France, France
| | - Emmanuelle Varon
- Laboratory of Microbiology and National Reference Centre for Pneumococci, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, Ile-de-France, France
| | - Muhamed-Kheir Taha
- Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus Influenzae, Institut Pasteur, Paris, Ile-de-France, France
| | - Stéphane Bonacorsi
- Laboratory of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, Ile-de-France, France
| | - Stéphane Béchet
- From the ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, Ile-de-France, France
| | - François Angoulvant
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, Ile-de-France, France
- Department of Pediatrics, Department Woman-Mother-Child, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), Lausanne, Vaud, Switzerland
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris Cité, Paris, Ile-de-France, France
- HeKA, Inria Paris, Université Paris Cité, Paris, Ile-de-France, France
| | - Robert Cohen
- From the ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, Ile-de-France, France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, Ile-de-France, France
- Research Center, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, Ile-de-France, France
- GEMINI, Groupe de Recherche Clinique-Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles, Institut Mondor de Recherche Biomédicale, Université Paris Est, Créteil, Ile-de-France, France
| | - Corinne Levy
- From the ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, Ile-de-France, France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, Ile-de-France, France
- Research Center, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, Ile-de-France, France
- GEMINI, Groupe de Recherche Clinique-Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles, Institut Mondor de Recherche Biomédicale, Université Paris Est, Créteil, Ile-de-France, France
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14
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Snoek L, van Kassel MN, Koelman DLH, van der Ende A, van Sorge NM, Brouwer MC, van de Beek D, Bijlsma MW. Recurrent bacterial meningitis in children in the Netherlands: a nationwide surveillance study. BMJ Open 2023; 13:e077887. [PMID: 38159962 PMCID: PMC10759068 DOI: 10.1136/bmjopen-2023-077887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES This study aimed to estimate the recurrence rate of culture-positive bacterial meningitis in children in the Netherlands. DESIGN Nationwide surveillance study, using the database of the Netherlands Reference Laboratory for Bacterial Meningitis to identify patients with culture-positive bacterial meningitis during childhood. SETTING The study was based in the Netherlands. PARTICIPANTS A total of 9731 children with a first bacterial meningitis episode between 1 July 1987 and 30 June 2019 were identified. PRIMARY AND SECONDARY OUTCOME MEASURES Recurrence was defined as a subsequent episode >28 days, or caused by a different pathogen. Annual incidence and incidence rate ratios (IRRs) comparing the periods 1988-2003 and 2004-2019 were calculated. Predictors of recurrent meningitis were assessed using Cox proportional hazards regression. RESULTS Sixty-three (0.6%) of the 9731 children with a first bacterial meningitis episode contracted recurrent meningitis. Neisseria meningitidis was the leading pathogen for first meningitis episodes (52%) and Streptococcus pneumoniae for recurrent episodes (52%). The median annual incidence of first episodes per 100 000 children decreased from 11.81 (IQR 11.26-17.60) in 1988-2003 to 2.60 (IQR 2.37-4.07) in 2004-2019 (IRR 0.25, 95% CI 0.23 to 0.26). The incidence of recurrences did not change: 0.06 (IQR 0.02-0.11) in 1988-2003 to 0.03 (IQR 0.00-0.06) in 2004-2019 (IRR 0.65, 95% CI 0.39 to 1.1). Age above 5 years (OR 3.6 (95% CI 1.5 to 8.3)) and a first episode due to Escherichia coli (OR 25.7 (95% CI 7.2 to 92.0)) were associated with higher risks of recurrence. CONCLUSION The recurrence rate of childhood bacterial meningitis in the Netherlands was 0.6%. While the incidence rate of first episodes decreased substantially, this was not the case for recurrent episodes. Older age and a first episode due to E. coli were associated with higher recurrence risks.
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Affiliation(s)
- Linde Snoek
- Department of Neurology, Amsterdam University Medical Centre location AMC, University of Amsterdam, Amsterdam, Netherlands
- Neuroinfection and Inflammation, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Merel N van Kassel
- Department of Neurology, Amsterdam University Medical Centre location AMC, University of Amsterdam, Amsterdam, Netherlands
- Neuroinfection and Inflammation, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Diederik L H Koelman
- Department of Neurology, Amsterdam University Medical Centre location AMC, University of Amsterdam, Amsterdam, Netherlands
- Neuroinfection and Inflammation, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Arie van der Ende
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
- Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam University Medical Centre location AMC, Amsterdam, Netherlands
| | - Nina M van Sorge
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
- Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam University Medical Centre location AMC, Amsterdam, Netherlands
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam University Medical Centre location AMC, University of Amsterdam, Amsterdam, Netherlands
- Neuroinfection and Inflammation, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam University Medical Centre location AMC, University of Amsterdam, Amsterdam, Netherlands
- Neuroinfection and Inflammation, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Merijn W Bijlsma
- Neuroinfection and Inflammation, Amsterdam Neuroscience, Amsterdam, Netherlands
- Department of Paediatrics, Amsterdam University Medical Centre location AMC, University of Amsterdam, Amsterdam, Netherlands
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15
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Pishori T, Furia FF, Manji K. A cross-sectional study of clinical features of bacterial meningitis among neonates presumed to have sepsis in a tertiary hospital, Dar es Salaam, Tanzania. Pan Afr Med J 2023; 46:123. [PMID: 38465011 PMCID: PMC10924605 DOI: 10.11604/pamj.2023.46.123.32787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/16/2023] [Indexed: 03/12/2024] Open
Abstract
Identifying meningitis among neonates is usually challenging given the non-specific presentation and overlap with neonatal sepsis. This study was aimed at determining the pertinent clinical features that would suggest bacterial meningitis among infants with signs of possible serious bacterial infection and their outcomes. This hospital-based cross-sectional study was conducted among neonates presenting with clinical features of sepsis admitted at Muhimbili National Hospital (MNH) between May and December 2015. Detailed clinical features, blood cultures, and cerebrospinal fluid were obtained. The specimens were tested at the Central Pathology Laboratory at MNH. Short-term clinical outcome was also determined for recruited participants. One hundred and twenty-six neonates met the inclusion criteria and were recruited, males were 67 (53.2%) and the mean age of participants was 10.4 ± 7.9 days. Features of meningitis were noted among 19% (24/126) and very low birth weight neonates were observed to have a statistically higher prevalence of meningitis (p=0.038). Bacterial isolates from cerebrospinal fluid (CSF) culture were Klebsiella spp and E. coli, while predominant isolates from blood culture were Klebsiella spp (35%) and E. coli (20.6%). There was high resistance to ampicillin (91.2%), cloxacillin (94.1%), gentamycin (50%), and ceftriaxone (50%). A high mortality of 24.9% was noted. Neonatal meningitis is common among neonates with sepsis, and bacterial isolates were resistant to routinely used antibiotics. High mortality attributed to meningitis was noted at Muhimbili National Hospital.
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Affiliation(s)
- Taher Pishori
- Department of Pediatrics, TMJ Hospital, Dar es Salaam, Tanzania
| | - Francis Fredrick Furia
- Department of Pediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Karim Manji
- Department of Pediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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16
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Van RN, Tubiana S, De Broucker T, Cédric J, Roy C, Meyohas MC, Prazuck T, Chirouze C, Hoen B, Duval X, Revest M. Persistent headaches one year after bacterial meningitis: prevalence, determinants and impact on quality of life. Eur J Clin Microbiol Infect Dis 2023; 42:1459-1467. [PMID: 37867184 DOI: 10.1007/s10096-023-04673-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 09/27/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Little is known on headaches long-term persistence after bacterial meningitis and on their impact on patients' quality of life. METHODS In an ancillary study of the French national prospective cohort of community-acquired bacterial meningitis in adults (COMBAT) conducted between February 2013 and July 2015, we collected self-reported headaches before, at onset, and 12 months (M12) after meningitis. Determinants of persistent headache (PH) at M12, their association with M12 quality of life (SF 12), depression (Center for Epidemiologic Studies Depression Scale) and neuro-functional disability were analysed. RESULTS Among the 277 alive patients at M12 87/274 (31.8%), 213/271 (78.6%) and 86/277 (31.0%) reported headaches before, at the onset, and at M12, respectively. In multivariate analysis, female sex (OR: 2.75 [1.54-4.90]; p < 0.001), pre-existing headaches before meningitis (OR: 2.38 [1.32-4.30]; p < 0.01), higher neutrophilic polynuclei percentage in the CSF of the initial lumbar puncture (OR: 1.02 [1.00-1.04]; p < 0.05), and brain abscess during the initial hospitalisation (OR: 8.32 [1.97-35.16]; p < 0.01) were associated with M12 persistent headaches. Neither the responsible microorganism, nor the corticoids use were associated with M12 persistent headaches. M12 neuro-functional disability (altered Glasgow Outcome Scale; p < 0.01), M12 physical handicap (altered modified Rankin score; p < 0.001), M12 depressive symptoms (p < 0.0001), and M12 altered physical (p < 0.05) and mental (p < 0.0001) qualities of life were associated with M12 headaches. CONCLUSION Persistent headaches are frequent one year after meningitis and are associated with quality of life alteration. CLINICAL TRIAL NCT01730690.
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Affiliation(s)
- Rémi Nguyen Van
- Infectious Diseases and Intensive Care Unit, UMR_1230, BRM (Bacterial RNA and Medicine), Inserm, CHU Rennes, Université Rennes 1, CIC-Inserm 1414, Rennes, France
| | - Sarah Tubiana
- IAME, Inserm UMR 1137, University Paris Diderot, Sorbonne Paris Cité, France
| | | | | | - Carine Roy
- Epidemiology, Biostatistics and Clinical Research Unit, Bichat Claude Bernard Hospital, APHP, Paris, France
| | | | | | | | - Bruno Hoen
- Infectious Diseases Unit, CHU Nancy, France
| | - Xavier Duval
- IAME, Inserm UMR 1137, University Paris Diderot, Sorbonne Paris Cité, France
- Centre d'investigation Clinique, Hôpital Bichat, APHP, Inserm CIC 1425, Paris, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, UMR_1230, BRM (Bacterial RNA and Medicine), Inserm, CHU Rennes, Université Rennes 1, CIC-Inserm 1414, Rennes, France.
- UMR-1230 BRM (Bacterial RNA and Medicine), Inserm, Université Rennes, Rennes, France.
- Centre d'investigation Clinique, CHU Rennes, Inserm CIC 1414, Rennes, France.
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Nielsen H, Storgaard M, Helweg-Larsen J, Larsen L, Jepsen MPG, Hansen BR, Wiese L, Bodilsen J. Group A Streptococcus Meningitis in Adults, Denmark. Emerg Infect Dis 2023; 29:1937-1939. [PMID: 37478289 PMCID: PMC10461673 DOI: 10.3201/eid2909.230627] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
We report a 21-fold increase in group A Streptococcus meningitis in adults in Denmark during October 13, 2022-April 12, 2023, concurrent with an outbreak of invasive streptococcal disease. We describe clinical characteristics of the outbreak cases and prognosis for patients in comparison to those for previous sporadic cases.
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18
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Weyori EW, Abubakari BB, Nkrumah B, Abdul-Karim A, Abiwu HAK, Kuugbee ED, Yidana A, Ziblim SD, Nuertey B, Weyori BA, Yakubu EB, Azure S, Koyiri VC, Adatsi RK. Predictive signs and symptoms of bacterial meningitis isolates in Northern Ghana. Sci Rep 2023; 13:13400. [PMID: 37591862 PMCID: PMC10435500 DOI: 10.1038/s41598-023-38253-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/05/2023] [Indexed: 08/19/2023] Open
Abstract
Cerebrospinal meningitis (CSM) is a public health burden in Ghana that causes up to 10% mortality in confirmed cases annually. About 20% of those who survive the infection suffer permanent sequelae. The study sought to understand the predictive signs and symptoms of bacterial meningitis implicated in its outcomes. Retrospective data from the Public Health Division, Ghana Health Service on bacterial meningitis from 2015 to 2019 was used for this study. A pre-tested data extraction form was used to collect patients' information from case-based forms kept at the Disease Control Unit from 2015 to 2019. Data were transcribed from the case-based forms into a pre-designed Microsoft Excel template. The data was cleaned and imported into SPSS version 26 for analysis. Between 2015 and 2019, a total of 2446 suspected bacterial meningitis cases were included in the study. Out of these, 842 (34.4%) were confirmed. Among the confirmed cases, males constituted majority with 55.3% of the cases. Children below 14 years of age were most affected (51.4%). The pathogens commonly responsible for bacterial meningitis were Neisseria meningitidis (43.7%) and Streptococcus pneumoniae (53.0%) with their respective strains Nm W135 (36.7%), Nm X (5.1%), Spn St. 1 (26.2%), and Spn St. 12F/12A/12B/44/4 (5.3%) accounting for more than 70.0% of the confirmed cases. The presence of neck stiffness (AOR = 1.244; C.I 1.026-1.508), convulsion (AOR = 1.338; C.I 1.083-1.652), altered consciousness (AOR = 1.516; C.I 1.225-1.876), and abdominal pains (AOR = 1.404; C.I 1.011-1.949) or any of these signs and symptoms poses a higher risk for testing positive for bacterial meningitis adjusting for age. Patients presenting one and/or more of these signs and symptoms (neck stiffness, convulsion, altered consciousness, and abdominal pain) have a higher risk of testing positive for bacterial meningitis after statistically adjusting for age.
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Affiliation(s)
| | | | | | - Abass Abdul-Karim
- Ghana Health Service, Northern Regional Health Directorate, Tamale, Ghana
| | | | | | | | | | | | | | - Etowi Boye Yakubu
- Ghana Health Service, Northern Regional Health Directorate, Tamale, Ghana
| | - Stebleson Azure
- Ghana Health Service, Northern Regional Health Directorate, Tamale, Ghana
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Raffaele JL, Sharma M, Berger S, Mitchell M, Lee C, Morrison J, Prasad M, Combs MD, Molas-Torreblanca K, Wood JK, Van Meurs A, Westphal K, Sawani A, Banker SL, Lee J, King C, Halvorson EE, Potisek NM. Prevalence of Invasive Bacterial Infection in Hypothermic Young Infants: A Multisite Study. J Pediatr 2023; 258:113407. [PMID: 37023947 DOI: 10.1016/j.jpeds.2023.113407] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/03/2023] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To determine the prevalence of bacteremia and meningitis (invasive bacterial infection [IBI]) in hypothermic young infants, and also to determine the prevalence of serious bacterial infections (SBI) and neonatal herpes simplex virus and to identify characteristics associated with IBI. STUDY DESIGN We conducted a retrospective cohort study of infants ≤90 days of age who presented to 1 of 9 hospitals with historical or documented hypothermia (temperature ≤36.0°C) from September 1, 2017, to May 5, 2021. Infants were identified by billing codes or electronic medical record search of hypothermic temperatures. All charts were manually reviewed. Infants with hypothermia during birth hospitalization, and febrile infants were excluded. IBI was defined as positive blood culture and/or cerebrospinal fluid culture treated as a pathogenic organism, whereas SBI also included urinary tract infection. We used multivariable mixed-effects logistic regression to identify associations between exposure variables and IBI. RESULTS Overall, 1098 young infants met the inclusion criteria. IBI prevalence was 2.1% (95% CI, 1.3-2.9) (bacteremia 1.8%; bacterial meningitis 0.5%). SBI prevalence was 4.4% (95% CI, 3.2-5.6), and neonatal herpes simplex virus prevalence was 1.3% (95% CI, 0.6-1.9). Significant associations were found between IBI and repeated temperature instability (OR, 4.9; 95% CI, 1.3-18.1), white blood cell count abnormalities (OR, 4.8; 95% CI, 1.8-13.1), and thrombocytopenia (OR, 5.0; 95% CI, 1.4-17.0). CONCLUSIONS IBI prevalence in hypothermic young infants is 2.1%. Further understanding of characteristics associated with IBI can guide the development decision tools for management of hypothermic young infants.
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Affiliation(s)
- Jennifer L Raffaele
- Department of Pediatrics, University of South Carolina School of Medicine Greenville, Prisma Health Children's Hospital-Upstate, Greenville, NC.
| | - Meenu Sharma
- Department of Pediatrics, University of Alabama Heersink School of Medicine, Birmingham, AL
| | - Stephanie Berger
- Department of Pediatrics, University of Alabama Heersink School of Medicine, Birmingham, AL
| | - Meredith Mitchell
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Clifton Lee
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - John Morrison
- Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Madhuri Prasad
- Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Monica D Combs
- Department of Pediatrics, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, CA
| | - Kira Molas-Torreblanca
- Department of Pediatrics, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, CA
| | - Julie K Wood
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Annalise Van Meurs
- Department of Pediatrics, Oregon Health and Science University, Doernbecher Children's Hospital, Portland, OR
| | - Kathryn Westphal
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Ali Sawani
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Sumeet L Banker
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY
| | - Jennifer Lee
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY
| | - Coleton King
- Department of Psychology, Clemson University, Clemson, SC
| | - Elizabeth E Halvorson
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Nicholas M Potisek
- Department of Pediatrics, University of South Carolina School of Medicine Greenville, Prisma Health Children's Hospital-Upstate, Greenville, NC; Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
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Soti Khiabani M, Mohammadi MS, Ashrafi MR, Haider SB, Haider SI, Mahmoudi S, Mamishi S. Evaluation of patients presenting with febrile seizures in an Iranian referral hospital: emphasis on the frequency of meningitis and co-infections. BMC Pediatr 2023; 23:316. [PMID: 37349740 PMCID: PMC10288671 DOI: 10.1186/s12887-023-04120-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Febrile seizures are one of the most common diseases that physicians encounter in pediatric emergency departments. Two important aspects of managing patients presenting with a febrile seizure are meningitis exclusion and co-infection investigation. This study was designed to determine any infection that occurs concomitantly with a febrile seizure episode and also to assess the frequency of meningitis among children presenting with febrile seizures. METHODS This retrospective cross-sectional study was conducted at the Children's Medical Center, an Iranian pediatric referral hospital. All patients aged 6 months to 5 years presenting with febrile seizures from 2020 to 2021 were included. Patients' data were collected from the medical report files. The presence of respiratory, gastrointestinal, and urinary infections was evaluated. Moreover, the detection of SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) was performed for suspicious cases. The results of urine and stool analysis, as well as blood, urine, and stool cultures were checked. The frequency of lumbar puncture (LP) performance and its results were studied. The relationship between white blood cells (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein in meningitis was evaluated. RESULTS A total of 290 patients were referred to the Children's Medical Center, Tehran, Iran, due to fever and seizures. The mean age of the patients was 21.5 ± 13.0 months, and 134 (46.2%) were female. Out of 290 patients, 17% presented with respiratory infections. Nasopharyngeal SARS-CoV-2 RT-PCR was requested for 50 patients (17%), of which nine (3%) were reported positive and two patients had multi-inflammatory syndrome in children (MIS-C). Fever without local signs, gastroenteritis, and urinary tract infections were found in 40%, 19%, and 14% of the patients, respectively. LP was requested for 97 participants (33.4%) to evaluate central nervous system infection, of which 22 cases were suggestive of aseptic meningitis. Among laboratory tests, leukocytosis was significantly related to aseptic meningitis (odds ratio = 11.1, 95% CI = 3.0- 41.5). The blood culture testing result was positive in seven patients; all of them were due to skin contamination. CONCLUSION Evaluation of patients for possible meningitis is necessary for febrile seizure management. Although the prevalence of bacterial meningitis in these patients is not high, according to this study and other studies conducted in Iran, aseptic meningitis, especially after Measles, Mumps, and Rubella (MMR) vaccination should be considered. Leukocytosis and increased CRP can predict the occurrence of aseptic meningitis in these patients. However, further studies with a larger sample size are highly recommended. Moreover, during the COVID-19 pandemic, it is recommended to pay attention to an acute COVID-19 infection or evidence of MIS-C in children with fever and seizure.
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Affiliation(s)
- Mahsa Soti Khiabani
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Pediatric Emergency Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahya Sadat Mohammadi
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Pediatric Emergency Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Ashrafi
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Pediatric Neurology Department, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Shima Mahmoudi
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran.
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, , Children's Medical Center Hospital, Dr. Gharib Street, Keshavarz Boulevard, I.R, Tehran, Iran.
- Biotechnology Centre, Silesian University of Technology, Gliwice, 44-100, Poland.
| | - Setareh Mamishi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, , Children's Medical Center Hospital, Dr. Gharib Street, Keshavarz Boulevard, I.R, Tehran, Iran.
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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21
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van der Putten BCL, Vlaminckx BJM, de Gier B, Freudenburg-de Graaf W, van Sorge NM. Group A Streptococcal Meningitis With the M1UK Variant in the Netherlands. JAMA 2023; 329:1791-1792. [PMID: 37027150 PMCID: PMC10082416 DOI: 10.1001/jama.2023.5927] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
This study reports an epidemiological assessment of laboratory-confirmed group A streptococcal meningitis cases in the Netherlands using more than 40 years of national bacteriological surveillance data.
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Affiliation(s)
- Boas C. L. van der Putten
- Epidemiology and Surveillance of Infectious Diseases, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Bart J. M. Vlaminckx
- Department of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Brechje de Gier
- Epidemiology and Surveillance of Infectious Diseases, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Nina M. van Sorge
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMCs, Amsterdam, the Netherlands
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22
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Aronson PL, Louie JP, Kerns E, Jennings B, Magee S, Wang ME, Gupta N, Kovaleski C, McDaniel LM, McDaniel CE. Prevalence of Urinary Tract Infection, Bacteremia, and Meningitis Among Febrile Infants Aged 8 to 60 Days With SARS-CoV-2. JAMA Netw Open 2023; 6:e2313354. [PMID: 37171815 PMCID: PMC10182434 DOI: 10.1001/jamanetworkopen.2023.13354] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/30/2023] [Indexed: 05/13/2023] Open
Abstract
Importance The prevalence of urinary tract infection (UTI), bacteremia, and bacterial meningitis in febrile infants with SARS-CoV-2 is largely unknown. Knowledge of the prevalence of these bacterial infections among febrile infants with SARS-CoV-2 can inform clinical decision-making. Objective To describe the prevalence of UTI, bacteremia, and bacterial meningitis among febrile infants aged 8 to 60 days with SARS-CoV-2 vs without SARS-CoV-2. Design, Setting, and Participants This multicenter cross-sectional study was conducted as part of a quality improvement initiative at 106 hospitals in the US and Canada. Participants included full-term, previously healthy, well-appearing infants aged 8 to 60 days without bronchiolitis and with a temperature of at least 38 °C who underwent SARS-CoV-2 testing in the emergency department or hospital between November 1, 2020, and October 31, 2022. Statistical analysis was performed from September 2022 to March 2023. Exposures SARS-CoV-2 positivity and, for SARS-CoV-2-positive infants, the presence of normal vs abnormal inflammatory marker (IM) levels. Main Outcomes and Measures Outcomes were ascertained by medical record review and included the prevalence of UTI, bacteremia without meningitis, and bacterial meningitis. The proportion of infants who were SARS-CoV-2 positive vs negative was calculated for each infection type, and stratified by age group and normal vs abnormal IMs. Results Among 14 402 febrile infants with SARS-CoV-2 testing, 8413 (58.4%) were aged 29 to 60 days; 8143 (56.5%) were male; and 3753 (26.1%) tested positive. Compared with infants who tested negative, a lower proportion of infants who tested positive for SARS-CoV-2 had UTI (0.8% [95% CI, 0.5%-1.1%]) vs 7.6% [95% CI, 7.1%-8.1%]), bacteremia without meningitis (0.2% [95% CI, 0.1%-0.3%] vs 2.1% [95% CI, 1.8%-2.4%]), and bacterial meningitis (<0.1% [95% CI, 0%-0.2%] vs 0.5% [95% CI, 0.4%-0.6%]). Among infants aged 29 to 60 days who tested positive for SARS-CoV-2, 0.4% (95% CI, 0.2%-0.7%) had UTI, less than 0.1% (95% CI, 0%-0.2%) had bacteremia, and less than 0.1% (95% CI, 0%-0.1%) had meningitis. Among SARS-CoV-2-positive infants, a lower proportion of those with normal IMs had bacteremia and/or bacterial meningitis compared with those with abnormal IMs (<0.1% [0%-0.2%] vs 1.8% [0.6%-3.1%]). Conclusions and Relevance The prevalence of UTI, bacteremia, and bacterial meningitis was lower for febrile infants who tested positive for SARS-CoV-2, particularly infants aged 29 to 60 days and those with normal IMs. These findings may help inform management of certain febrile infants who test positive for SARS-CoV-2.
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Affiliation(s)
- Paul L. Aronson
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey P. Louie
- Division of Emergency Medicine, University of Minnesota, Masonic Children's Hospital, Minneapolis
| | - Ellen Kerns
- Division of Child Health Policy, Department of Pediatrics, University of Nebraska Medical Center, Omaha
| | | | - Sloane Magee
- American Academy of Pediatrics, Itasca, Illinois
| | - Marie E. Wang
- Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford, Palo Alto, California
| | - Nisha Gupta
- Division of Hospital Medicine, Inova Children’s Hospital, Falls Church, Virginia
| | - Christopher Kovaleski
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Inova Children’s Hospital, Falls Church, Virginia
| | - Lauren M. McDaniel
- Division of Hospital Medicine, Department of Pediatrics, Johns Hopkins Children’s Center, Baltimore, Maryland
- Now with Division of Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle
| | - Corrie E. McDaniel
- Division of Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle
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23
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Mrozowska-Nyckowska K, Zbrzeźniak J, Paradowska-Stankiewicz I. Meningitis and encephalitis in Poland in 2021. Przegl Epidemiol 2023; 77:387-402. [PMID: 38334321 DOI: 10.32394/pe.77.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Introduction Meningitis meningitis and/or encephalitis regardless of etiology are subject to monitoring in Poland as part of routine epidemiological surveillance. In this paper, meningitis and/or encephalitis in 2021 caused by Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae and tick-borne encephalitis virus are discussed in detail. In Poland, immunoprophylaxis in the form of mandatory or recommended vaccinations is used to prevent diseases caused by the aforementioned etiological agents. Aim of the study The aim of this study was to assess the epidemiological incidence of meningoencephalitis and encephalitis in Poland, in 2021 including analysis of the impact of the COVID-19 pandemic. Material and methods To analyse the epidemiological situation of neuroinfections in Poland, we used data sent to NIPH NIH - NRI by Voivodeship Sanitary and Epidemiological Stations and published in the annual bulletin: "Infectious diseases and poisonings in Poland in 2021" and "Protective vaccination in Poland in 2021" as well as individual epidemiological interviews recorded in the EpiBase system. Results In 2021, a total of 973 cases of meningitis and/or encephalitis were registered in Poland. This is a 16.1% increase in the number of cases compared to 2020, but still a 57% decrease in the number of cases compared to 2019 when 2,249 cases were recorded. For infections of bacterial etiology, including cases of neuroborreliosis, the number of cases increased by 38.3% (from 376 to 520, incidence from 0.96 to 1.76 per 100,000). Compared to 2020 and 2019, the incidence of meningitis and/or encephalitis of N. meningitidis decreased by 10.7% (from 0.13 to 0.15) and 47.4% (from 0.25 to 0.13), respectively, and for H. influenzae by 75% (from 0.01 to 0.03) and 70% (from 0.01 to 0.03). For S. pneumoniae, we can speak of an increase in incidence against 2020 of 57.1% (121 vs 77 cases, incidence 0.32 vs 0.20) and a decrease against 2019. (121 vs 190, incidence 0.32 vs 0.47). Infections of viral etiology accounted for 47% of all registered cases. There was a slight decrease in their number, by 2% (from 462 to 453 cases). In addition, there was an increase in cases of tick-borne encephalitis, from 158 in 2020 to 210 in 2021 (an increase of 32.9%), and a decrease in cases from 265 in 2019 (a decrease of 20.8%). Summary and conclusions 2021 showed an overall upward trend in the number of recorded cases of bacterial meningitis and/or encephalitis, and a slight decrease in the number of viral meningitis and/or encephalitis cases compared to 2020. Still, the observed number of meningitis and/or encephalitis cases in 2021, both bacterial and viral incidences, remains below the levels observed in the pre-pandemic COVID-19 period (2019). As a result of the SARS-CoV-2 outbreak, the introduction of measures to limit the transmission of the SARS-CoV-2 virus has been observed to reduce the spread of other droplet- and airborne pathogens, thus also pathogens such as S. pneumoniae, H.influenzae and N. menningitidis.
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Affiliation(s)
- Karolina Mrozowska-Nyckowska
- National Institute of Public Health NIH - National Research Institute, Department of Epidemiology of Infectious Diseases and Surveillance
| | - Jakub Zbrzeźniak
- National Institute of Public Health NIH - National Research Institute, Department of Epidemiology of Infectious Diseases and Surveillance
| | - Iwona Paradowska-Stankiewicz
- National Institute of Public Health NIH - National Research Institute, Department of Epidemiology of Infectious Diseases and Surveillance
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24
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Çay Ü, Alabaz D, Özgür Gündeşlioğlu Ö, Kibar F, Çetin C, Oktay K. Experience with enterococcal meningitis/ventriculitis in children. Pediatr Int 2023; 65:e15398. [PMID: 36305209 DOI: 10.1111/ped.15398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Enterococcal infections are increasingly common in hospitalized patients. Enterococcal meningitis/ventriculitis (EMV) is an extremely rare condition of enterococcal infections, occurring particularly in children. This study investigated the clinical and microbiological characteristics, predisposing factors, and prognosis in pediatric patients with EMV. METHODS Pediatric patients (<18 years) diagnosed with EMV were retrospectively evaluated over 10 years. RESULTS The study included a total of 25 isolates from 24 patients, median age 23 months (range: 1-136 months). The most common symptoms included vomiting, fever, and headache, with hydrocephalus shunt and preterm birth being the two most common conditions. Commonly associated infections, with central nervous system (CNS) devices as a predisposing factor, were due to external ventricular drainage and ventriculoperitoneal shunts. Two patients with spontaneous meningitis were preterm infant. Of the isolates, 44% were Enterococcus faecalis, 44% E. faecium, and 12% E. gallinarum. Five (20%) isolates were vancomycin resistant. Twelve patients were resistant to anti-enterococcal antibiotics, including ampicillin, ciprofloxacin, imipenem, teicoplanin, gentamicin, and linezolid (40%, 20%, 8%, 8%, 4%, and 4%, respectively). Enterococcus faecium was more resistant to ampicillin, ciprofloxacin, teicoplanin, and vancomycin than E. faecalis. The median treatment duration was 17 days (interquartile range: 14-26 days).The mortality rate was 8.3% (2/24; both associated with vancomycin resistance). CONCLUSIONS Neurosurgical conditions are the most common predisposing factors for EMV. Preterm birth is an important predisposing factor in children. Because EMV is nonspecific in clinical findings, it should be considered when there is an underlying CNS disorder and empirical treatment should begin in this direction.
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Affiliation(s)
- Ümmühan Çay
- Pediatric Infectious Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Derya Alabaz
- Pediatric Infectious Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
| | | | - Filiz Kibar
- Department of Microbiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ceren Çetin
- Department of Pediatric Infectious Diseases, Kartal Dr Lutfi Kırdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kadir Oktay
- Department of Neurosurgery, Faculty of Medicine, Çukurova University, Adana, Turkey
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25
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Hasbun R. Progress and Challenges in Bacterial Meningitis: A Review. JAMA 2022; 328:2147-2154. [PMID: 36472590 DOI: 10.1001/jama.2022.20521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Bacterial meningitis is a worldwide health problem, with incidence rates ranging from approximately 0.9 per 100 000 individuals per year in high-income countries to 80 per 100 000 individuals per year in low-income countries. In low-income countries, bacterial meningitis has a mortality rate of up to 54%. Up to 24% of those who survive develop chronic neurological sequelae, such as hearing loss or focal neurological deficits. OBSERVATIONS Streptococcus pneumoniae causes about 72% and Neisseria meningitidis causes about 11% of cases of bacterial meningitis in people older than 16 years. Escherichia coli and Streptococcus agalactiae cause about 35% of cases of early-onset neonatal meningitis. In adults, risk factors for bacterial meningitis include older age and immunosuppressive conditions. The most common symptoms are headache (84%), fever (74%), stiff neck (74%), altered mental status (median [IQR] Glasgow Coma Scale score of 11 [9-14] on a scale ranging from 3-15), and nausea (62%). Brain imaging should be performed before lumbar puncture if patients present with altered mental status, focal neurological deficits, papilledema, or history of immunocompromising conditions or central nervous system disease. Bacterial meningitis should be suspected if any of the following are present on admission: serum leukocytes greater than 10.0 ×109/L, cerebrospinal fluid (CSF) leukocytes greater than 2000/μL, CSF granulocytes greater than 1180/μL, CSF protein greater than 2.2 g/L, CSF glucose less than 34.23 mg/dL, or fever. A positive Gram stain result for bacteria is diagnostic, but the sensitivity of a positive Gram stain result for bacterial meningitis ranges from 50% to 90%. In countries in which the prevalence of ceftriaxone-resistant Streptococcus pneumoniae exceeds 1%, vancomycin and ceftriaxone are the empirical antibiotics of choice, with the addition of ampicillin in neonates, older patients, and immunocompromised patients. Adjunctive dexamethasone should be used in patients with bacterial meningitis but stopped if Listeria monocytogenes is confirmed. CONCLUSIONS AND RELEVANCE Bacterial meningitis affects approximately 0.9 per 100 000 individuals to 80 per 100 000 individuals per year and has a mortality rate as high as 54%. First-line therapy is prompt empirical intravenous antibiotic therapy and adjunctive dexamethasone.
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Affiliation(s)
- Rodrigo Hasbun
- Section of Infectious Diseases, UT Health McGovern Medical School, Houston, Texas
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26
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Alanazi GA, Alrashidi AS, Alqarni KS, khozym SAA, Alenzi S. Meningitis post-cochlear implant and role of vaccination. Saudi Med J 2022; 43:1300-1308. [PMID: 36517062 PMCID: PMC9994524 DOI: 10.15537/smj.2022.43.12.20220426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/05/2022] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES To investigate the incidence, risk factors, and management of meningitis in cochlear implant (CI)users. METHODS A systematic review was carried out using PubMed, Scopus, Web of Science, and Cochrane Central Register. Articles were considered relevant if reported any data on incidence, clinical presentations, the role of vaccination, management, and outcomes of meningitis after CI. RESULTS A total of 32 studies including 27358 patients were included, and meningitis was reported in only 202 cases. Meningitis occurred in the period ranging from 1 day to 72 months after CI. A total of 55 patients received the pneumococcal vaccine, while 20 patients received the Haemophilus influenzae type B vaccine. A large number of participants (n=47) had associated anatomical malformations, while 62 had otitis media before meningitis. A total of 24 cases required revision surgery along with medical treatment. Full recovery was the outcome reported by the included studies in 19 patients. CONCLUSION Cochlear implant users seem to be at possible risk of bacterial meningitis at any time after implantation, especially in the presence of risk factors, such as otitis media and anatomical malformations of the cochlea.
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Affiliation(s)
- Ghadah A. Alanazi
- From the Faculty of Medicine(Alanazi, Alrashidi), Tabuk University; from the Department of Otolaryngology (Alqarni, khozym, Alenzi), King Fahad Specialist Hospital, Tabuk, Kingdom of Saudi Arabia.
| | - Aumniyat S. Alrashidi
- From the Faculty of Medicine(Alanazi, Alrashidi), Tabuk University; from the Department of Otolaryngology (Alqarni, khozym, Alenzi), King Fahad Specialist Hospital, Tabuk, Kingdom of Saudi Arabia.
| | - Khalid S. Alqarni
- From the Faculty of Medicine(Alanazi, Alrashidi), Tabuk University; from the Department of Otolaryngology (Alqarni, khozym, Alenzi), King Fahad Specialist Hospital, Tabuk, Kingdom of Saudi Arabia.
| | - Saeed A. Al khozym
- From the Faculty of Medicine(Alanazi, Alrashidi), Tabuk University; from the Department of Otolaryngology (Alqarni, khozym, Alenzi), King Fahad Specialist Hospital, Tabuk, Kingdom of Saudi Arabia.
| | - Saad Alenzi
- From the Faculty of Medicine(Alanazi, Alrashidi), Tabuk University; from the Department of Otolaryngology (Alqarni, khozym, Alenzi), King Fahad Specialist Hospital, Tabuk, Kingdom of Saudi Arabia.
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Wang CY, Xu HM, Tian J, Hong SQ, Liu G, Wang SX, Gao F, Liu J, Liu FR, Yu H, Wu X, Chen BQ, Shen FF, Zheng G, Yu J, Shu M, Liu L, Du LJ, Li P, Xu ZW, Zhu MQ, Huang LS, Huang HY, Li HB, Huang YY, Wang D, Wu F, Bai ST, Tang JJ, Shan QW, Lan LC, Zhu CH, Xiong Y, Tian JM, Wu JH, Hao JH, Zhao HY, Lin AW, Song SS, Lin DJ, Zhou QH, Guo YP, Wu JZ, Yang XQ, Zhang XH, Guo Y, Cao Q, Luo LJ, Tao ZB, Yang WK, Zhou YK, Chen Y, Feng LJ, Zhu GL, Zhang YH, Xue P, Li XQ, Tang ZZ, Zhang DH, Su XW, Qu ZH, Zhang Y, Zhao SY, Qi ZZ, Pang L, Wang CY, Deng HL, Liu XL, Chen YH, Shu S. [A multicenter epidemiological study of acute bacterial meningitis in children]. Zhonghua Er Ke Za Zhi 2022; 60:1045-1053. [PMID: 36207852 DOI: 10.3760/cma.j.cn112140-20220608-00522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children. Methods: A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher's exact test, while non-normal distrituction numeric variables were compared with nonparametric test. Results: Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia, Escherichia coli, and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs. 17.3% (142/820), 13.0% (103/790) vs. 9.1% (75/820), 4.6% (36/790) vs. 2.7% (22/820), χ2=18.71, 6.20, 4.07, all P<0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P>0.05). Conclusions: The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae, and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.
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Affiliation(s)
- C Y Wang
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - H M Xu
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - J Tian
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - S Q Hong
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - G Liu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - S X Wang
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - F Gao
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - J Liu
- Department of Infectious Diseases, Hunan Children's Hospital, Changsha 410007, China
| | - F R Liu
- Department of Infectious Diseases, Hunan Children's Hospital, Changsha 410007, China
| | - H Yu
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - X Wu
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - B Q Chen
- Department of Infectious Diseases, Anhui Provincial Children's Hospital, Hefei 230022, China
| | - F F Shen
- Department of Infectious Diseases, Anhui Provincial Children's Hospital, Hefei 230022, China
| | - G Zheng
- Department of Neurology, Children's Hospital of Nanjing Medical University,Nanjing 210008, China
| | - J Yu
- Department of Neurology, Children's Hospital of Nanjing Medical University,Nanjing 210008, China
| | - M Shu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610044, China
| | - L Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610044, China
| | - L J Du
- Department of Neurology, Children's Hospital of Shanxi, Taiyuan 030006, China
| | - P Li
- Department of Neurology, Children's Hospital of Shanxi, Taiyuan 030006, China
| | - Z W Xu
- Department of Infectious Diseases, the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - M Q Zhu
- Department of Infectious Diseases, the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - L S Huang
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - H Y Huang
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - H B Li
- Department of Pediatrics, the First Hospital of Jilin University, Changchu 130061, China
| | - Y Y Huang
- Department of Pediatrics, the First Hospital of Jilin University, Changchu 130061, China
| | - D Wang
- Department of Neurology, the Affiliated Children's Hospital of Xi'an Jiao Tong University, Xi'an 710002, China
| | - F Wu
- Department of Neurology, the Affiliated Children's Hospital of Xi'an Jiao Tong University, Xi'an 710002, China
| | - S T Bai
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - J J Tang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Q W Shan
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University,Nanning 530021, China
| | - L C Lan
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University,Nanning 530021, China
| | - C H Zhu
- Department of Infectious Diseases, Jiangxi Provincial Children's Hospital, Nanchang 330006, China
| | - Y Xiong
- Department of Infectious Diseases, Jiangxi Provincial Children's Hospital, Nanchang 330006, China
| | - J M Tian
- Department of Infectious Diseases, Children's Hospital of Soochow University,Suzhou 215002, China
| | - J H Wu
- Department of Infectious Diseases, Children's Hospital of Soochow University,Suzhou 215002, China
| | - J H Hao
- Department of Infectious Diseases, Kaifeng Children's Hospital, Kaifeng 475000, China
| | - H Y Zhao
- Department of Infectious Diseases, Kaifeng Children's Hospital, Kaifeng 475000, China
| | - A W Lin
- Department of Infectious Diseases, Children's Hospital Affiliated Shandong University, Jinan 250022, China
| | - S S Song
- Department of Infectious Diseases, Children's Hospital Affiliated Shandong University, Jinan 250022, China
| | - D J Lin
- Department of Infectious Diseases, Hainan Women and Children's Medical Center, Haikou 571103, China
| | - Q H Zhou
- Department of Infectious Diseases, Hainan Women and Children's Medical Center, Haikou 571103, China
| | - Y P Guo
- Department of Infectious Diseases, Hainan Women and Children's Medical Center, Haikou 571103, China
| | - J Z Wu
- Department of Pediatrics, Women's and Children's Hospital Affiliated to Xiamen University, Xiamen 361003, China
| | - X Q Yang
- Department of Pediatrics, Women's and Children's Hospital Affiliated to Xiamen University, Xiamen 361003, China
| | - X H Zhang
- Department of Neonatology, Children's Hospital of Shanxi, Taiyuan 030006, China
| | - Y Guo
- Department of Neonatology, Children's Hospital of Shanxi, Taiyuan 030006, China
| | - Q Cao
- Department of Infectious Diseases, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - L J Luo
- Department of Infectious Diseases, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Z B Tao
- Department of Pediatrics, the First Hospital of Lanzhou University, Lanzhou 730013, China
| | - W K Yang
- Department of Pediatrics, the First Hospital of Lanzhou University, Lanzhou 730013, China
| | - Y K Zhou
- Department of Pediatrics, the First Hospital of Lanzhou University, Lanzhou 730013, China
| | - Y Chen
- Department of Pediatrics, the Second Hospital of Hebei Medical University, Shijiazhuang 050004, China
| | - L J Feng
- Department of Pediatrics, the Second Hospital of Hebei Medical University, Shijiazhuang 050004, China
| | - G L Zhu
- Department of Infection and Digestive, Qinghai Province Women and Children's Hospital, Xining 810007, China
| | - Y H Zhang
- Department of Infection and Digestive, Qinghai Province Women and Children's Hospital, Xining 810007, China
| | - P Xue
- Department of Pediatrics, Taiyuan Maternal and Child Health Care Hospital, Taiyuan 030012, China
| | - X Q Li
- Department of Pediatrics, Taiyuan Maternal and Child Health Care Hospital, Taiyuan 030012, China
| | - Z Z Tang
- Department of Pediatrics, the First People's Hospital of Zunyi, Zunyi 563099, China
| | - D H Zhang
- Department of Pediatrics, the First People's Hospital of Zunyi, Zunyi 563099, China
| | - X W Su
- Department of Pediatrics, Inner Mongolia People's Hospital, Inner Mongolia 750306, China
| | - Z H Qu
- Department of Pediatrics, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Y Zhang
- Department of Pediatrics, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - S Y Zhao
- Department of Infectious Diseases, Hangzhou Children's Hospital, Hangzhou 310005, China
| | - Z Z Qi
- Department of Infectious Diseases, Hangzhou Children's Hospital, Hangzhou 310005, China
| | - L Pang
- Department of Pediatrics, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
| | - C Y Wang
- Department of Pediatrics, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
| | - H L Deng
- Department of Pediatrics, Xi'an Central Hospital, Xi'an 710004, China
| | - X L Liu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Y H Chen
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Sainan Shu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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28
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Mahajan P, VanBuren JM, Tzimenatos L, Cruz AT, Vitale M, Powell EC, Leetch AN, Pickett ML, Brayer A, Nigrovic LE, Dayan PS, Atabaki SM, Ruddy RM, Rogers AJ, Greenberg R, Alpern ER, Tunik MG, Saunders M, Muenzer J, Levine DA, Hoyle JD, Lillis KG, Gattu R, Crain EF, Borgialli D, Bonsu B, Blumberg S, Anders J, Roosevelt G, Browne LR, Cohen DM, Linakis JG, Jaffe DM, Bennett JE, Schnadower D, Park G, Mistry RD, Glissmeyer EW, Cator A, Bogie A, Quayle KS, Ellison A, Balamuth F, Richards R, Ramilo O, Kuppermann N. Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results. Pediatrics 2022; 150:e2021055633. [PMID: 36097858 PMCID: PMC9648158 DOI: 10.1542/peds.2021-055633] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/24/2022] Open
Abstract
It is unknown whether febrile infants 29 to 60 days old with positive urinalysis results require routine lumbar punctures for evaluation of bacterial meningitis. OBJECTIVE To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results. METHODS Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results. RESULTS Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference in the prevalence of bacterial meningitis in infants ≤28 days of age with positive versus negative UA results (∼1% in both groups). However, among 697 infants aged 29 to 60 days with positive UA results, there were no cases of bacterial meningitis in comparison to 9 of 4153 with negative UA results (0.2%, difference -0.2% [-0.4% to -0.1%]). In addition, there were no cases of bacteremia and/or bacterial meningitis in the 148 infants ≤60 days of age with positive UA results who had the Pediatric Emergency Care Applied Research Network low-risk blood thresholds of absolute neutrophil count <4 × 103 cells/mm3 and procalcitonin <0.5 ng/mL. CONCLUSIONS Among noncritical febrile infants ≤60 days of age with positive UA results, there were no cases of bacterial meningitis in those aged 29 to 60 days and no cases of bacteremia and/or bacterial meningitis in any low-risk infants based on low-risk blood thresholds in both months of life. These findings can guide lumbar puncture use and other clinical decision making.
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Affiliation(s)
- Prashant Mahajan
- Division of Emergency Medicine, Department of Pediatrics,
Children's Hospital of Michigan, Wayne State University, Detroit,
Michigan
| | - John M. VanBuren
- Department of Pediatrics, Primary Children’s
Medical Center, University of Utah, Salt Lake City, Utah
| | | | - Andrea T. Cruz
- Sections of Emergency Medicine and Infectious Diseases,
Department of Pediatrics, Texas Children’s Hospital, Baylor College of
Medicine, Houston, Texas
| | - Melissa Vitale
- Division of Pediatric Emergency Medicine, Department of
Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth C. Powell
- Division of Emergency Medicine, Department of Pediatrics,
Ann & Robert H. Lurie Children’s Hospital, Northwestern University
Feinberg School of Medicine, Chicago, Illinois
| | - Aaron N. Leetch
- Departments of Emergency Medicine and Pediatrics,
University of Arizona College of Medicine, Tucson, Arizona
| | - Michelle L. Pickett
- Section of Pediatric Emergency Medicine, Department of
Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anne Brayer
- Departments of Emergency Medicine and Pediatrics,
University of Rochester Medical Center, Rochester, New York
| | - Lise E. Nigrovic
- Division of Emergency Medicine, Boston Children’s
Hospital, Harvard University, Boston, Massachusetts
| | - Peter S. Dayan
- Division of Emergency Medicine, Department of
Pediatrics, Columbia University College of Physicians & Surgeons, New York
City, New York
| | - Shireen M. Atabaki
- Division of Emergency Medicine, Department of
Pediatrics, Children’s National Medical Center, The George Washington School
of Medicine and Health Sciences, Washington, District of Columbia
| | - Richard M. Ruddy
- Division of Emergency Medicine, Cincinnati
Children’s Hospital Medical Center, Department of Pediatrics, University of
Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alexander J. Rogers
- Departments of Pediatrics
- Department of Emergency Medicine, University of
Michigan, Ann Arbor, Michigan
| | - Richard Greenberg
- Department of Pediatrics, Primary Children’s
Medical Center, University of Utah, Salt Lake City, Utah
| | - Elizabeth R. Alpern
- Division of Emergency Medicine, Department of
Pediatrics, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | | | - Mary Saunders
- Section of Pediatric Emergency Medicine, Department of
Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jared Muenzer
- Department of Pediatrics, St. Louis Children’s
Hospital, Washington University, St. Louis, Missouri
| | - Deborah A. Levine
- Department of Pediatrics
- Department of Emergency Medicine, Bellevue Hospital, New
York University Langone Medical Center, New York City, New York
| | - John D. Hoyle
- Department of Emergency Medicine, Helen DeVos
Children’s Hospital of Spectrum Health, Grand Rapids, Michigan
| | - Kathleen Grisanti Lillis
- Department of Pediatrics, Women and Children’s
Hospital of Buffalo, State University of New York at Buffalo, Buffalo, New
York
| | - Rajender Gattu
- Division of Emergency Medicine, Department of
Pediatrics, University of Maryland Medical Center, Baltimore, Maryland
| | - Ellen F. Crain
- Department of Pediatrics, Jacobi Medical Center, Albert
Einstein College of Medicine, New York City, New York
| | - Dominic Borgialli
- Department of Emergency Medicine, University of
Michigan, Ann Arbor, Michigan
- Department of Emergency Medicine, Hurley Medical Center,
Flint, Michigan
| | - Bema Bonsu
- Section of Emergency Medicine, Department of Pediatrics,
Nationwide Children’s Hospital, Columbus, Ohio
| | - Stephen Blumberg
- Department of Pediatrics, Jacobi Medical Center, Albert
Einstein College of Medicine, New York City, New York
| | - Jennifer Anders
- Department of Pediatrics, Johns Hopkins University,
Baltimore, Maryland
| | - Genie Roosevelt
- Department of Pediatrics, The Colorado
Children’s Hospital, University of Colorado-Denver, Denver, Colorado
| | - Lorin R. Browne
- Section of Pediatric Emergency Medicine, Department of
Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - James G. Linakis
- Departments of Emergency Medicine and Pediatrics, Brown
University and Hasbro Children’s Hospital, Providence, Rhode Island
| | - David M. Jaffe
- Department of Pediatrics, St. Louis Children’s
Hospital, Washington University, St. Louis, Missouri
| | - Jonathan E. Bennett
- Division of Pediatric Emergency Medicine, Alfred I.
duPont Hospital for Children, Nemours Children's Health System, Wilmington,
Delaware
| | - David Schnadower
- Department of Pediatrics, St. Louis Children’s
Hospital, Washington University, St. Louis, Missouri
| | - Grace Park
- Department of Emergency Medicine, Pediatric Emergency
Medicine, The University of New Mexico, Albuquerque, New Mexico
| | - Rakesh D. Mistry
- Department of Pediatrics, The Colorado
Children’s Hospital, University of Colorado-Denver, Denver, Colorado
| | - Eric W. Glissmeyer
- Department of Pediatrics, Primary Children’s
Medical Center, University of Utah, Salt Lake City, Utah
| | - Allison Cator
- Departments of Pediatrics
- Department of Emergency Medicine, University of
Michigan, Ann Arbor, Michigan
| | - Amanda Bogie
- Division of Emergency Medicine, Department of
Pediatrics, The University of Oklahoma College of Medicine, Oklahoma City,
Oklahoma
| | - Kimberly S. Quayle
- Department of Pediatrics, St. Louis Children’s
Hospital, Washington University, St. Louis, Missouri
| | - Angela Ellison
- Division of Emergency Medicine, Department of
Pediatrics, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | - Fran Balamuth
- Division of Emergency Medicine, Department of
Pediatrics, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | - Rachel Richards
- Department of Pediatrics, Primary Children’s
Medical Center, University of Utah, Salt Lake City, Utah
| | - Octavio Ramilo
- Division of Pediatric Infectious Diseases and Center
for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State
University, Columbus, Ohio
| | - Nathan Kuppermann
- Departments of Emergency Medicine
- Pediatrics, University of California Davis School of
Medicine, Sacramento, California
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29
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Mazumder S, Faruque MA, Masud AA, Sultana A, Sultana N, Kabir M, Islam S, Choudhury SA, Rahman H, Mannan KA, Saha BK. Clinical Profile and Immediate Outcome of Pyogenic Meningitis in Children. Mymensingh Med J 2022; 31:1020-1026. [PMID: 36189547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Meningitis literally means inflammation of the meninges. It is mostly caused by bacteria, virus, fungus and protozoa and pyogenic meningitis constitutes a serious neurological disorder associated with significant morbidity and mortality in developing countries. This study was carried out to evaluate the clinical presentation and immediate outcome of pyogenic meningitis in children. This was a prospective observational study and conducted at department of Paeditrics in Cumilla Medical College Hospital, Cumilla, Bangladesh from July 2014 to June 2015. Total 50 children were diagnosed as pyogenic meningitis fulfilling the inclusion criteria was included in this study. Cases were enrolled purposively. Immediately after admission through history and clinical examination, complete blood count, random blood sugar, Cerebrospinal fluid (CSF) examination and blood culture was done in all patients. For statistical analysis chi-square test was done and significance of analysis was made when p value <0.05. This study includes patients aged between 2 months to 12 years and male female ratio was 1.5:1. Several risk factors like male sex (60.0%), age below one year (42.0%), Protein energy malnutrition (PEM) (30.0%), not exclusively breastfed (44.0%) were identified. Common presenting complaints were fever (100.0%), convulsion (96.0%), altered consciousness (42.0%) and vomiting (38.0%). Common physical signs were neck rigidity (56.0%), Kernig's sign (26.0%) and bulged fontanelle (34.0%). CSF was hazy in 54.0%, clear in 38.0% and turbid in 08.0% cases, CSF protein was more than 100mg/dl in 90.0% of the cases and glucose was less than 40mg/dl in most of the cases (94.0%). Streptococcus Pneumoniae (49.0%) followed by Neisseria Meningitidis (38.0%) were the two most commonly isolated organism responsible for pyogenic meningitis. Mortality rate during hospital stay was 18.0% and complications developed in 18.0% of cases. To avoid maltreatment in our resource limited setting due to failure of identifying organism, this study might help to administer appropriate antibiotics against organism and to reduce morbidity and mortality in meningitis. This study revealed less mortality rate in our country than neighbors and severe malnutrition important risk factors for the burden of pyogenic meningitis. It requires large scale multicentre studies to establish the whole scenario of Bangladesh.
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Affiliation(s)
- S Mazumder
- Dr Simul Mazumder, Resident Physician (Paediatrics), Cumilla Medical College Hospital. Cumilla, Bangladesh
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30
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Zheng H, Li MS, Wu D, Yan TT, An ZJ, Li YX. [Interpretation of defeating meningitis by 2030: a global road map]. Zhonghua Yu Fang Yi Xue Za Zhi 2022; 56:1348-1352. [PMID: 36207902 DOI: 10.3760/cma.j.cn112150-20220217-00148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Meningitis is a life-threatening disease. In order to reduce its threat to public health, the World Health Assembly indorsed a resolution in 2020 for urgent global action to prevent and control meningitis. Defeating Meningitis by 2030: a Global Roadmap was officially launched by the World Health Organization in 2021. We interpreted some key information of the roadmap from the aspects of coverage, objectives and pillar strategies, providing ideas for further strengthening the prevention and control of bacterial meningitis in China.
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Affiliation(s)
- H Zheng
- Department of National Immunization Program,Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - M S Li
- Department of National Immunization Program,Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - D Wu
- Department of National Immunization Program,Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - T T Yan
- Department of National Immunization Program,Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Z J An
- Department of National Immunization Program,Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Y X Li
- Department of National Immunization Program,Chinese Center for Disease Control and Prevention, Beijing 100050, China
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31
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Meng L, Peng XL, Xu HY, Chen DD, Zhang H, Hu Y. A Nomogram to Predict Bacterial Meningitis-associated Hydrocephalus: A Single-Center Retrospective Study. Pediatr Infect Dis J 2022; 41:706-713. [PMID: 35622426 DOI: 10.1097/inf.0000000000003590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to develop a predictive nomogram for the early detection of hydrocephalus in children with bacterial meningitis. METHODS This retrospective study was based on data of children with bacterial meningitis admitted to our hospital between January 2016 and December 2020. Risk factors were evaluated using univariate analysis, and the predictive model/nomogram was built using binary logistic analysis. A nomogram calibration plot, Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve evaluated the predictive performance. Ordinary bootstrapping processed the internal validation. RESULTS We enrolled 283 patients who matched the inclusion criteria, among whom 41 cases (14.49%) had confirmed bacterial meningitis-associated hydrocephalus (BMAH). The incidence of sequelae in the patients with BMAH was 88.9% (24/27), which was significantly higher than that in the patients without BMAH. Univariate regression analysis revealed that 14 clinical indicators were associated with BMAH. Multivariate analysis identified 4 variables as independent risk factors to establish the predictive model: repeated seizures, loss of consciousness, procalcitonin ≥7.5 ng/dL and mechanical ventilation. And a graphical nomogram was designed. The area under the ROC curve was 0.910. In the Hosmer-Lemeshow test the P value was 0.610. The mean absolute error in the calibration plot was 0.02. Internal validation showed the testing set was in good accordance with the original set when internal validation was performed. CONCLUSIONS The predictive model/nomogram of BMAH could be used by clinicians to determine hydrocephalus risk.
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Affiliation(s)
- Linxue Meng
- From the Department of Neurology, Children's Hospital of Chongqing Medical University, China
- Ministry of Education Key Laboratory of Child Development and Disorders, China
- National Clinical Research Center for Child Health and Disorders, Chongqing
- China International Science and Technology Cooperation base of Child development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics
| | - Xiao-Ling Peng
- Division of Science and Technology, Beijing Normal University-Hongkong Baptist Univesity United International College
| | - Hao-Yue Xu
- Department of Orthopedics, Joint Disease & Sport Medicine Center, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Dou-Dou Chen
- From the Department of Neurology, Children's Hospital of Chongqing Medical University, China
- Ministry of Education Key Laboratory of Child Development and Disorders, China
- National Clinical Research Center for Child Health and Disorders, Chongqing
- China International Science and Technology Cooperation base of Child development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics
| | - Han Zhang
- From the Department of Neurology, Children's Hospital of Chongqing Medical University, China
- Ministry of Education Key Laboratory of Child Development and Disorders, China
- National Clinical Research Center for Child Health and Disorders, Chongqing
- China International Science and Technology Cooperation base of Child development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics
| | - Yue Hu
- From the Department of Neurology, Children's Hospital of Chongqing Medical University, China
- Ministry of Education Key Laboratory of Child Development and Disorders, China
- National Clinical Research Center for Child Health and Disorders, Chongqing
- China International Science and Technology Cooperation base of Child development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics
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32
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Snoek L, Gonçalves BP, Horváth-Puhó E, van Kassel MN, Procter SR, Søgaard KK, Chandna J, van der Ende A, van de Beek D, Brouwer MC, Sørensen HT, Lawn JE, Bijlsma MW. Short-term and long-term risk of mortality and neurodevelopmental impairments after bacterial meningitis during infancy in children in Denmark and the Netherlands: a nationwide matched cohort study. The Lancet Child & Adolescent Health 2022; 6:633-642. [PMID: 35798010 PMCID: PMC9365703 DOI: 10.1016/s2352-4642(22)00155-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022]
Abstract
Background Few studies have reported the long-term consequences of bacterial meningitis during infancy, and studies that have been done usually do not include a comparison cohort. We aimed to assess short-term and long-term risk of mortality, neurodevelopmental impairment (NDI), and health-care use and household income in cohorts of children with and without a history of bacterial meningitis during infancy in Denmark and the Netherlands. Methods In this nationwide cohort study, infants with a history of bacterial meningitis before age 1 year were identified through the Danish Medical Birth Registry and Danish National Patient Registry using International Classification of Diseases (ICD)-10 codes and through the Netherlands Reference Laboratory for Bacterial Meningitis. Infants were matched (1:10) by sex and birth month and year to a comparison cohort of the general population without a history of bacterial meningitis. We analysed mortality using Cox proportional hazards regression. In Denmark, diagnoses of NDIs were based on ICD-10 codes; in the Netherlands, special educational needs were used as a functional NDI outcome. Risk ratios (RRs) of NDIs were estimated using modified Poisson regression. We also analysed long-term health-care use in Denmark and household income in both countries. All regression analyses were adjusted for sex and year of birth, and stratified by pathogen whenever sample size allowed. Findings We included 2216 children with a history of bacterial meningitis (570 [25·7%] in Denmark between Jan 1, 1997, and Dec 31, 2018, and 1646 [74·3%] in the Netherlands between Jan 1, 1995, and Dec 31, 2018), matched to 22 127 comparison cohort members. Median age at diagnosis was 2·8 months (IQR 0·4–7·1) in Denmark and 4·3 months (0·7–7·4) in the Netherlands. Mortality risks within 3 months after disease onset were 3·9% (95% CI 2·6–5·8%) in Denmark and 5·9% (4·7–7·0) in the Netherlands, compared with 0·0% (p<0·0001) and 0·1% (p<0·0001) in the comparison cohorts. Survivors had an increased risk of moderate or severe NDIs at age 10 years (RR 5·0 [95% CI 3·5–7·1] in Denmark and 4·9 [4·0–6·2] in the Netherlands) compared to children in the comparison cohort, particularly after pneumococcal and group B streptococcal meningitis. In Denmark, a history of bacterial meningitis was associated with increased health-care use in the 10 years following diagnosis (rate ratio 4·5 [95% CI 3·9–5·2] for outpatient visits and 4·1 [3·6–4·7] for hospital admissions). Interpretation Our study shows increased risk of mortality in the short and long term, a five times increase in risk of NDIs, and increased health-care use after bacterial meningitis during infancy. Together with context-specific incidence data, our results can advance pathogen-specific estimation of the meningitis burden and inform service provision at the individual and population level. Funding Bill & Melinda Gates Foundation, the Stichting Remmert Adriaan Laan Fonds, and the Netherlands Organisation for Health Research and Development.
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Affiliation(s)
- Linde Snoek
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Neuroscience, Neuroinfection and Inflammation, Amsterdam, Netherlands
| | - Bronner P Gonçalves
- Maternal, Adolescent, Reproductive and Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Merel N van Kassel
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Neuroscience, Neuroinfection and Inflammation, Amsterdam, Netherlands
| | - Simon R Procter
- Maternal, Adolescent, Reproductive and Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kirstine K Søgaard
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark; Department of Clinical Microbiology, Aalborg University Hospital and Aalborg University, Aalborg, Denmark
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive and Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Arie van der Ende
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Neuroscience, Neuroinfection and Inflammation, Amsterdam, Netherlands
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Neuroscience, Neuroinfection and Inflammation, Amsterdam, Netherlands
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Merijn W Bijlsma
- Department of Paediatrics, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Neuroscience, Neuroinfection and Inflammation, Amsterdam, Netherlands.
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Ikumapayi UN, Hill PC, Hossain I, Olatunji Y, Ndiaye M, Badji H, Manjang A, Salaudeen R, Ceesay L, Adegbola RA, Greenwood BM, Mackenzie GA. Childhood meningitis in rural Gambia: 10 years of population-based surveillance. PLoS One 2022; 17:e0265299. [PMID: 35947593 PMCID: PMC9365145 DOI: 10.1371/journal.pone.0265299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background The introduction in many countries of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to significant reductions in acute bacterial meningitis (ABM) in children. However, recent population-based data on ABM in sub-Saharan Africa are limited. Methods Population-based surveillance for meningitis was carried out in a rural area of The Gambia under demographic surveillance from 2008 to 2017, using standardised criteria for referral, diagnosis and investigation. We calculated incidence using population denominators. Results We diagnosed 1,666 patients with suspected meningitis and collected cerebrospinal fluid (n = 1,121) and/or blood (n = 1,070) from 1,427 (88%) of cases. We identified 169 cases of ABM, 209 cases of suspected non-bacterial meningitis (SNBM) and 1,049 cases of clinically suspected meningitis (CSM). The estimated average annual incidence of ABM was high at 145 per 100,000 population in the <2-month age group, 56 per 100,000 in the 2–23-month age group, but lower at 5 per 100,000 in the 5–14-year age group. The most common causes of ABM were Streptococcus pneumoniae (n = 44), Neisseria meningitidis (n = 42), and Gram-negative coliform bacteria (n = 26). Eighteen of 22 cases caused by pneumococcal serotypes included in PCV13 occurred prior to vaccine introduction and four afterwards. The overall case fatality ratio for ABM was 29% (49/169) and was highest in the <2-month age group 37% (10/27). The case fatality ratio was 8.6% (18/209) for suspected non-bacterial meningitis and 12.8% (134/1049) for clinically suspected meningitis cases. Conclusions Gambian children continue to experience substantial morbidity and mortality associated with suspected meningitis, especially acute bacterial meningitis. Such severely ill children in sub-Saharan Africa require improved diagnostics and clinical care.
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Affiliation(s)
- Usman N. Ikumapayi
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- * E-mail:
| | - Philip C. Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Ilias Hossain
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Yekini Olatunji
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Malick Ndiaye
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Henry Badji
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ahmed Manjang
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Lamin Ceesay
- Ministry of Health, Gambia Government, Banjul, The Gambia
| | - Richard A. Adegbola
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- RAMBICON, Immunisation & Global Health Consulting, Lekki, Lagos, Nigeria
| | | | - Grant A. Mackenzie
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Murdoch Children’s Research Institute, Parkville, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Abstract
Sickle cell disease (SCD) was found in 10% of children with bacterial meningitis (BM) in Luanda, 5-fold more than in the general population. BM children with SCD versus BM children without SCD had higher inflammatory markers, more often had pneumococcal meningitis (71% vs. 39%), and either died (39% vs. 22%) or had a longer hospital stay (15 vs. 11 days).
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Affiliation(s)
- Tuula Pelkonen
- From the Pediatrics, University of Helsinki and Helsinki University Hospital
| | - Irmeli Roine
- Faculty of Medicine, University Diego Portales, Santiago, Chile
| | | | - Kirsi Jahnukainen
- From the Pediatrics, University of Helsinki and Helsinki University Hospital
- New Children’s Hospital, Pediatric Research Center, Helsinki, Finland
| | - Heikki Peltola
- From the Pediatrics, University of Helsinki and Helsinki University Hospital
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de la Torre M, Gómez B, Velasco R. Value of Temperature for Predicting Invasive Bacterial Infection in Febrile Infants: A Spanish Pediatric Emergency Research Group (RISeuP-SPERG) Study. Pediatr Emerg Care 2022; 38:e1294-e1297. [PMID: 35436771 DOI: 10.1097/pec.0000000000002729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to analyze the prevalence of invasive bacterial infection (IBI) among infants younger than 90 days with fever without source according to the degree of fever. METHODS We performed a secondary analysis of a multicenter study with 19 participating Spanish pediatric emergency departments that included 3401 febrile infants 90 days or younger. RESULTS Prevalence of IBI was 3.2% (5.3% among infants <29 days old, 2.5% among those 29-60 days old, and 2.2% among those 61-90 days old). Prevalence of bacteremia increased with the degree of fever, meanwhile the prevalence of bacterial meningitis did not. No cutoff point was useful for ruling out an IBI safely. Overall, 46.7% of the IBIs were diagnosed in patients with temperature <38.6° (sensitivity, 53.3%; negative likelihood ratio, 0.81). CONCLUSIONS Performing blood tests should be recommended in infants 90 days or younger with temperature ≥38°C without source regardless of the degree of fever.
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Affiliation(s)
| | - Borja Gómez
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo
| | - Roberto Velasco
- Pediatric Emergency Department, Rio Hortega Universitary Hospital, Valladolid, Spain
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Rahimi BA, Ishaq N, Mudaser GM, Taylor WR. Outcome of acute bacterial meningitis among children in Kandahar, Afghanistan: A prospective observational cohort study. PLoS One 2022; 17:e0265487. [PMID: 35404980 PMCID: PMC9000062 DOI: 10.1371/journal.pone.0265487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Acute bacterial meningitis (ABM) is an important cause of morbidity and mortality in children but there are no published data on the treatment outcomes of ABM in Afghanistan. METHODS We conducted a prospective observational cohort study over one year, February 2020 to January 2021 in a tertiary care hospital in Kandahar, Afghanistan. AMB was diagnosed clinically and on lumbar puncture findings. Binary logistic regression assessed factors for death. RESULTS A total of 393 ABM children of mean age 4.8 years were recruited. Most were males [231 (58.8%)], living in rural areas [267 (67.9%)] and in households of >10 inhabitants [294 (74.8%)]. Only 96 (24.4%) had received against both Haemophilus influenzae type b (Hib) or pneumococcal (PCV) vaccines. Children were treated with combination of ceftriaxone and ampicillin and 169/321 (52.6%) received dexamethasone. Of the 321 children with a known outcome, 69 (21.5%) died. Death was significantly associated with: not receiving dexamethasone [adjusted odds ratio (AOR) 4.9 (95% CI 2.6-9.5, p <0.001)], coma on admission [AOR 4.6 (I 2.3-9.5, p <0.001)], no PCV [AOR 2.8 (1.2-6.6, p = 0.019)] or Hib vaccine [AOR 2.8 (1.2-6.6, p = 0.019)], and being male [AOR 2.7 (1.4-5.5, p = 0.005). CONCLUSIONS ABM causes significant morbidity and mortality in Afghan children that may be improved by greater use of PCV and Hib vaccines. Adjunct dexamethasone should be evaluated formally in our setting.
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Affiliation(s)
- Bilal Ahmad Rahimi
- Department of Pediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
- Research Unit of Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Niamatullah Ishaq
- Department of Radiology, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | | | - Walter R. Taylor
- Mahidol Oxford Tropical Medicine Clinical Research unit (MORU), Mahidol University, Bangkok, Thailand
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Pelkonen T, Roine I, Kallio M, Jahnukainen K, Peltola H. Prevalence and significance of anaemia in childhood bacterial meningitis: a secondary analysis of prospectively collected data from clinical trials in Finland, Latin America and Angola. BMJ Open 2022; 12:e057285. [PMID: 35288394 PMCID: PMC8921951 DOI: 10.1136/bmjopen-2021-057285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To describe the prevalence and severity of anaemia and to examine its associations with outcome in children with bacterial meningitis (BM). DESIGN Secondary analysis of descriptive data from five randomised BM treatment trials. SETTING Hospitals in Finland, Latin America and Angola. PARTICIPANTS Consecutive children from 2 months to 15 years of age admitted with BM and who had haemoglobin (Hb) measured on admission. OUTCOME MEASURES Prevalence and degree of anaemia using the WHO criteria, and their associations with recovery with sequelae or death. RESULTS The median Hb was 11.8 g/dL in Finland (N=341), 9.2 g/dL in Latin America (N=597) and 7.6 g/dL in Angola (N=1085). Of the children, 79% had anaemia, which was severe in 29%, moderate in 58% and mild in 13% of cases. Besides study area, having anaemia was independently associated with age <1 year, treatment delay >3 days, weight-for-age z-score <-3 and other than meningococcal aetiology. Irrespective of the study area, anaemia correlated with the markers of disease severity. In children with severe to moderate anaemia (vs mild or no anaemia), the risk ratio for death was 3.38 and for death or severe sequelae was 3.07. CONCLUSION Anaemia, mostly moderate, was common in children with BM, especially in Angola, in underweight children, among those with treatment delay, and in pneumococcal meningitis. Poor outcome was associated with anaemia in all three continents. TRIAL REGISTRATION NUMBER The registration numbers of Angolan trials were ISRCTN62824827 and NCT01540838.
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Affiliation(s)
- Tuula Pelkonen
- New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Pediatric Research Center, Helsinki, Finland
- Hospital Pediátrico David Bernardino, Luanda, Angola
| | - Irmeli Roine
- Faculty of Medicine, University Diego Portales, Santiago, Chile
| | - Markku Kallio
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kirsi Jahnukainen
- New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Pediatric Research Center, Helsinki, Finland
| | - Heikki Peltola
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Harden LM, Leahy S, Lala SG, Paul P, Chandna J, Lowick S, Mbatha S, Jaye T, Laughton B, Ghoor A, Sithole P, Msayi J, Kumalo N, Msibi TN, Madhi SA, Lawn JE, Dangor Z. South African Children: A Matched Cohort Study of Neurodevelopmental Impairment in Survivors of Invasive Group B Streptococcus Disease Aged 5 to 8 Years. Clin Infect Dis 2022; 74:S5-S13. [PMID: 34725706 PMCID: PMC8776309 DOI: 10.1093/cid/ciab814] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Invasive group B Streptococcus (iGBS) sepsis and meningitis are important causes of child mortality, but studies on neurodevelopmental impairment (NDI) after iGBS are limited. Using Griffiths Mental Development Scales-Extended Revised (GMDS-ER), we described NDI in iGBS survivors and non-iGBS children from South Africa, as part of a 5-country study. METHODS We identified children aged 5-8 years with a history of iGBS and children with no history of iGBS between October 2019 and January 2021. Children were matched on sex, and birth data (month, year) (matched cohort study). Moderate or Severe NDI was the primary outcome as a composite of GMDS-ER motor, GMDS-ER cognition, hearing, and vision. Secondary outcomes included mild NDI, any emotional-behavioral problems, and GMDS-ER developmental quotients (DQ) calculated by dividing the age equivalent GMDS-ER score by the chronological age. RESULTS In total, 160 children (iGBS survivors, 43; non-iGBS, 117) were assessed. Among iGBS survivors 13 (30.2%) had meningitis, and 30 (69.8%) had sepsis. Six (13.9%) iGBS survivors, and 5 (4.3%) non-iGBS children had moderate or severe NDI. Children who survived iGBS were 5.56 (95% confidence interval [CI]: 1.07-28.93; P = .041) times more likely to have moderate or severe NDI at 5-8 years than non-iGBS children. Compared to the non-iGBS children, iGBS meningitis survivors had a significantly lower global median DQ (P < .05), as well as a lower median DQ for the language GMDS-ER subscale and performance GMDS-ER subscale (P < .05). CONCLUSIONS Children surviving iGBS, particularly meningitis, are more likely to have NDI at 5-8 years compared to non-iGBS children. Further research is required to improve detection and care for at-risk newborns.
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Affiliation(s)
- Lois M Harden
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Proma Paul
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Lowick
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Mbatha
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tamara Jaye
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Barbara Laughton
- Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Azra Ghoor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pamela Sithole
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacqueline Msayi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ntombifuthi Kumalo
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshepiso N Msibi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Manara R, Avato I, Uberti A, Trevisi P, Bovo R, Martini A, Brotto D, Berettini S, Canzi P, Ciorba A, Cristofari E, Cuda D, Della Volpe A, Frau GN, Genovese E, Marsella P, Murri A, Sorrentino F, Vincenti V, Zanetti D. Bulging of the Oval Window in Common Cavity Deformity: A Possible Predictor of Meningitis. Otol Neurotol 2022; 43:101-104. [PMID: 34699400 DOI: 10.1097/mao.0000000000003394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the prevalence-rate of oval window bulging in the common cavity and its association with bacterial meningitis. PATIENTS CT and clinical files of 29 children with preliminary diagnosis of common cavity deformity were collected from 13 Italian centers. INTERVENTION A retrospective case review study was conducted with a centralized evaluation of the temporal bone CT imaging was performed at Azienda Ospedale - Università Padova, Padova, Italy. MAIN OUTCOME MEASURE Diagnosis of common cavity was reviewed; in addition, a fluid protrusion into the middle-ear cavity through the oval window at CT imaging was considered as oval window bulging. Its association with the history of bacterial meningitis was investigated. RESULTS Common cavity deformity was confirmed in 14/29 children (mean-age 11.4 ± 3.8; age-range 5-20; nine females) referred with this diagnosis. In 7/14 patients, the common cavity deformity was bilateral (i.e., 21 common cavities). Oval window bulging was found in 3/19 common cavities (concomitant middle-ear effusive otitis hampered the evaluation in two cases), while the internal acoustic meatus fundus was defective in 10/21 cases. History of bacterial meningitis was found in three children (21%) and two of them had oval window bulging at CT. In the case unrelated to oval window bulging, meningitis occurred late at the age of 12 during acute otitis contralateral to common cavity deformity (ipsilaterally to incomplete partition type 1). CONCLUSION Patients harboring common cavity deformity have a high risk of meningitis in their first years of life. Oval window bulging seems to be associated with a higher risk of meningitis. This information might be important for appropriate surgical planning.
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Affiliation(s)
- Renzo Manara
- Neuroradiology Unit, Department of Neurosciences, University of Padova, Padova
| | - Irene Avato
- Experimental Medicine, University of Pavia, Pavia, Italy
| | - Andrea Uberti
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Patrizia Trevisi
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Roberto Bovo
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Alessandro Martini
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Davide Brotto
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | | | - Pietro Canzi
- Department of Otorhinolaryngology, University of Pavia, Pavia
| | - Andrea Ciorba
- ENT Department, University Hospital of Ferrara, Ferrara
| | | | | | | | | | - Elisabetta Genovese
- Department of Diagnostic, Clinical and Public Health, University of Modena and Reggio Emilia, Modena
| | - Pasquale Marsella
- Audiology and Otosurgery Unit, "Bambino Gesù" Pediatric Hospital, Rome
- University of Parma
| | | | - Flavia Sorrentino
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Vincenzo Vincenti
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Parma; and Unit of Surgical Pathology, University of Parma, Parma
| | - Diego Zanetti
- Audiology Unit, Dept of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Terwin K, Ferreira M, Minnie C, Marangellis K, Darby R, Berlyn J, Kleingeld A, Tiel S, Benedict MOA, van Rooyen C, Adefuye AO, Sempa JB. The epidemiological profile of meningitis among adults in a South African district hospital. Pan Afr Med J 2022; 41:256. [PMID: 35734322 PMCID: PMC9188002 DOI: 10.11604/pamj.2022.41.256.30015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/04/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kian Terwin
- Undergraduate Medical Programme, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
| | - Mari Ferreira
- Undergraduate Medical Programme, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
| | - Christiaan Minnie
- Undergraduate Medical Programme, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
| | - Kalliopy Marangellis
- Undergraduate Medical Programme, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
| | - Ruben Darby
- Undergraduate Medical Programme, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
| | - Jesse Berlyn
- Undergraduate Medical Programme, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
| | - Anél Kleingeld
- Undergraduate Medical Programme, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
| | - Shezree Tiel
- Undergraduate Medical Programme, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
| | | | - Cornel van Rooyen
- Department of Biostatistics, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
| | - Anthonio Oladele Adefuye
- Division of Health Sciences Education, Office of the Dean, Faculty of Health Sciences, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
- Corresponding author: Anthonio Oladele Adefuye, Division of Health Sciences Education, Office of the Dean, Faculty of Health Sciences, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa.
| | - Joseph Bukulu Sempa
- Department of Biostatistics, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
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Wang H, Zhu X. Cerebrospinal fluid culture-positive bacterial meningitis increases the risk for neurologic damage among neonates. Ann Med 2021; 53:2199-2204. [PMID: 34787529 PMCID: PMC8604535 DOI: 10.1080/07853890.2021.2004318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/03/2021] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE This study aimed to compare the clinical features and outcomes of neonatal bacterial meningitis (NBM) between patients with positive and negative cerebrospinal fluid (CSF) cultures and determine the risk factors for CSF culture-positive NBM. METHODS We retrospectively reviewed the medical records of all patients with NBM. Perinatal clinical data, laboratory results, and cranial radiographs were obtained. RESULTS Among the 186 neonates who met the inclusion criteria. The risk factors for positive CSF culture results were analysed using multiple logistic regression. The multivariable logistic regression analysis showed that the possible risk factors of NBM with positive CSF culture in this study were: Length of fever [OR = 1.126; 95% CI (0.999-1.268)], Neurologic symptoms [OR = 3.043; 95% CI (1.164-7.959)], Cerebrospinal fluid protein [OR = 1.001; 95% CI (1.000-1.001)]. Cases of NBM with a longer duration of fever, more neurologic symptoms, and higher levels of CSF protein were more likely to demonstrate positive results on CSF culture. CONCLUSION Cases of NBM with CSF culture-positive results were more likely to have severe clinical manifestations and develop more serious neurologic damage. Patients with NBM who have longer durations of fever, more neurologic symptoms, and higher levels of CSF protein were more likely to have CSF culture-positive results, who should be followed up more closely.Key MessageBacterial meningitis is clinically defined as a serious inflammation of meningitis, usually caused by a variety of bacterial infections that may leave sequelae and long-term complications and high mortality rates. Early diagnosis is often difficult, particularly when the patient has been treated with antimicrobials.
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Affiliation(s)
- Huawei Wang
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Xueping Zhu
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou City, Jiangsu Province, China
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ter Horst L, Brouwer MC, van der Ende A, van de Beek D. Recurrent Community-Acquired Bacterial Meningitis in Adults. Clin Infect Dis 2021; 73:e2545-e2551. [PMID: 33751028 PMCID: PMC8563215 DOI: 10.1093/cid/ciaa1623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recurrent bacterial meningitis has been found to occur in about 5% of meningitis cases. METHODS We analyzed adults with recurrent episodes in a prospective nationwide cohort study of community-acquired bacterial meningitis. RESULTS Of 2264 episodes of community-acquired bacterial meningitis between 2006 and 2018, 143 (6%) were identified as recurrent episodes in 123 patients. The median age was 57 years (interquartile range [IQR], 43-66), and 57 episodes (46%) occurred in men. The median duration between the first and the current episode was 5 years (IQR, 1-15). For 82 of 123 patients (67%), it was the first recurrent episode, 31 patients had 2-5 previous episodes (25%), 2 had 6-10 episodes (2%), and 2 had >10 episodes (2%). Predisposing factors were identified in 87 of 118 patients (74%) and most commonly consisted of ear or sinus infections (43 of 120, 36%) and cerebrospinal fluid leakage (37 of 116, 32%). The most common pathogens were Streptococcus pneumoniae (93 of 143, 65%) and Haemophilus influenzae (19 of 143, 13%). The outcome was unfavorable (Glasgow outcome scale score, <5) in 24 episodes with recurrent meningitis (17%) vs 810 for nonrecurrent meningitis patients (39%, P < .001). Six of 143 died (4%) vs 362 of 2095 patients (17%, P < .001). CONCLUSIONS Recurrent meningitis occurs mainly in patients with ear or sinus infections and cerebrospinal fluid leakage. Predominant causative pathogens are S. pneumoniae and H. influenzae. The disease course is less severe, resulting in lower case fatality compared with nonrecurrent meningitis patients.
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Affiliation(s)
- Liora ter Horst
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands; Amsterdam University Medical Centers, University of Amsterdam
| | - Matthijs C Brouwer
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands; Amsterdam University Medical Centers, University of Amsterdam
| | - Arie van der Ende
- Amsterdam University Medical Centers, University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam University Medical Centers, University of Amsterdam, Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands; Amsterdam University Medical Centers, University of Amsterdam
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Abstract
BACKGROUND Studies evaluating the epidemiology of pediatric meningitis are limited in our region. This study aimed to describe recent trends in the incidence of pediatric meningitis. METHODS We estimated national trends in hospitalization rates for pediatric meningitis (<18 years) by analyzing data from the Health Insurance Review and Assessment database between 2010 and 2018. Meningitis cases were identified based on International Classification of Diseases, Tenth Revision (ICD-10) codes and hospitalization rates were calculated. RESULTS In this national population-based study, a total of 119,644 hospitalizations and 58 deaths due to pediatric meningitis were identified. The hospitalization rates of pediatric bacterial meningitis have declined by 50.0%, from 3.4 per 100,000 in 2010 to 1.7 per 100,000 in 2018. The mortality rates for bacterial and viral meningitis were 2.0% and 0.002%, respectively. Despite the decreased annual incidence of bacterial meningitis, its mortality rate did not change significantly during the study period. The only risk factor identified for mortality in bacterial meningitis patients among age group, sex, region of residence, and season was age below 1 year (P < 0.001). As children under 1 year have a high-mortality rate (4.2%), patients in this age group require close monitoring. The reasons behind indistinct seasonal patterns of bacterial meningitis warrant further investigation. CONCLUSIONS Childhood bacterial meningitis has shown a significant decline in incidence from 2010 to 2018. In contrast, viral meningitis has not shown a trend over time. Knowledge of these changes may aid clinicians in the decision-making process and management of meningitis patients.
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Affiliation(s)
- Bit Gyeol Kim
- From the Department of Pediatrics, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Gangdong-gu, Seoul, Republic of Korea
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Nakamura T, Cohen AL, Schwartz S, Mwenda JM, Weldegebriel G, Biey JNM, Katsande R, Ghoniem A, Fahmy K, Rahman HA, Videbaek D, Daniels D, Singh S, Wasley A, Rey-Benito G, de Oliveira L, Ortiz C, Tondo E, Liyanage JBL, Sharifuzzaman M, Grabovac V, Batmunkh N, Logronio J, Heffelfinger J, Fox K, De Gouveia L, von Gottberg A, Du Plessis M, Kwambana-Adams B, Antonio M, El Gohary S, Azmy A, Gamal A, Voropaeva E, Egorova E, Urban Y, Duarte C, Veeraraghavan B, Saha S, Howden B, Sait M, Jung S, Bae S, Litt D, Seaton S, Slack M, Antoni S, Ouattara M, Van Beneden C, Serhan F. The Global Landscape of Pediatric Bacterial Meningitis Data Reported to the World Health Organization-Coordinated Invasive Bacterial Vaccine-Preventable Disease Surveillance Network, 2014-2019. J Infect Dis 2021; 224:S161-S173. [PMID: 34469555 PMCID: PMC8409679 DOI: 10.1093/infdis/jiab217] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) coordinates the Global Invasive Bacterial Vaccine-Preventable Diseases (IB-VPD) Surveillance Network to support vaccine introduction decisions and use. The network was established to strengthen surveillance and laboratory confirmation of meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. METHODS Sentinel hospitals report cases of children <5 years of age hospitalized for suspected meningitis. Laboratories report confirmatory testing results and strain characterization tested by polymerase chain reaction. In 2019, the network included 123 laboratories that follow validated, standardized testing and reporting strategies. RESULTS From 2014 through 2019, >137 000 suspected meningitis cases were reported by 58 participating countries, with 44.6% (n = 61 386) reported from countries in the WHO African Region. More than half (56.6%, n = 77 873) were among children <1 year of age, and 4.0% (n = 4010) died among those with reported disease outcome. Among suspected meningitis cases, 8.6% (n = 11 798) were classified as probable bacterial meningitis. One of 3 bacterial pathogens was identified in 30.3% (n = 3576) of these cases, namely S. pneumoniae (n = 2177 [60.9%]), H. influenzae (n = 633 [17.7%]), and N. meningitidis (n = 766 [21.4%]). Among confirmed bacterial meningitis cases with outcome reported, 11.0% died; case fatality ratio varied by pathogen (S. pneumoniae, 12.2%; H. influenzae, 6.1%; N. meningitidis, 11.0%). Among the 277 children who died with confirmed bacterial meningitis, 189 (68.2%) had confirmed S. pneumoniae. The proportion of pneumococcal cases with pneumococcal conjugate vaccine (PCV) serotypes decreased as the number of countries implementing PCV increased, from 77.8% (n = 273) to 47.5% (n = 248). Of 397 H. influenzae specimens serotyped, 49.1% (n = 195) were type b. Predominant N. meningitidis serogroups varied by region. CONCLUSIONS This multitier, global surveillance network has supported countries in detecting and serotyping the 3 principal invasive bacterial pathogens that cause pediatric meningitis. Streptococcus pneumoniae was the most common bacterial pathogen detected globally despite the growing number of countries that have nationally introduced PCV. The large proportions of deaths due to S. pneumoniae reflect the high proportion of meningitis cases caused by this pathogen. This global network demonstrated a strong correlation between PCV introduction status and reduction in the proportion of pneumococcal meningitis infections caused by vaccine serotypes. Maintaining case-based, active surveillance with laboratory confirmation for prioritized vaccine-preventable diseases remains a critical component of the global agenda in public health.The World Health Organization (WHO)-coordinated Invasive Bacterial Vaccine-Preventable Disease (IB-VPD) Surveillance Network reported data from 2014 to 2019, contributing to the estimates of the disease burden and serotypes of pediatric meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis.
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Affiliation(s)
- Tomoka Nakamura
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Adam L Cohen
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Stephanie Schwartz
- Division of Bacterial Diseases, US Centers for Disease Control and Prevention, Global Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, National Center for Immunization and Respiratory Disease, Atlanta, Georgia, USA
| | - Jason M Mwenda
- Department of Vaccine Preventable Diseases Program, World Health Organization Regional Office for Africa, Brazzaville, Congo Republic
| | - Goitom Weldegebriel
- Department of Immunization, Vaccines and Biologicals, World Health Organization Regional Office for Africa, Inter-Support Team for East and South Africa, Harare, Zimbabwe
| | - Joseph N M Biey
- Department of Vaccine Preventable Diseases, World Health Organization Regional Office for Africa, Inter-Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Reggis Katsande
- Department of Vaccine Preventable Diseases Program, World Health Organization Regional Office for Africa, Brazzaville, Congo Republic
| | - Amany Ghoniem
- Department of Communicable Diseases, Immunization, Vaccines and Biologicals Unit, World Health Organization Eastern Mediterranean Office, Cairo, Egypt
| | - Kamal Fahmy
- Department of Communicable Diseases, Immunization, Vaccines and Biologicals Unit, World Health Organization Eastern Mediterranean Office, Cairo, Egypt
| | - Hossam Abdel Rahman
- Department of Communicable Diseases, Immunization, Vaccines and Biologicals Unit, World Health Organization Eastern Mediterranean Office, Cairo, Egypt
| | - Dovile Videbaek
- Division of Country Health Programmes, Vaccine-Preventable Diseases and Immunization Unit, World Health Organization European Regional Office, Copenhagen, Denmark
| | - Danni Daniels
- Division of Country Health Programmes, Vaccine-Preventable Diseases and Immunization Unit, World Health Organization European Regional Office, Copenhagen, Denmark
| | - Simarjit Singh
- Division of Country Health Programmes, Vaccine-Preventable Diseases and Immunization Unit, World Health Organization European Regional Office, Copenhagen, Denmark
| | - Annemarie Wasley
- Division of Country Health Programmes, Vaccine-Preventable Diseases and Immunization Unit, World Health Organization European Regional Office, Copenhagen, Denmark
| | - Gloria Rey-Benito
- Pan American Health Organization/Department of Family, Health Promotion, and Life Course, World Health Organization Regional Office for the Americas, Comprehensive Family Immunization Unit, Washington DC, USA
| | - Lucia de Oliveira
- Pan American Health Organization/Department of Family, Health Promotion, and Life Course, World Health Organization Regional Office for the Americas, Comprehensive Family Immunization Unit, Washington DC, USA
| | - Claudia Ortiz
- Pan American Health Organization/Department of Family, Health Promotion, and Life Course, World Health Organization Regional Office for the Americas, Comprehensive Family Immunization Unit, Washington DC, USA
| | - Emmanuel Tondo
- Department of Immunization and Vaccine Development, World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Jayantha B L Liyanage
- Department of Immunization and Vaccine Development, World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Mohammad Sharifuzzaman
- Department of Immunization and Vaccine Development, World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Varja Grabovac
- Division of Programmes for Diseases Control, Vaccine Preventable Diseases and Immunization, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Nyambat Batmunkh
- Division of Programmes for Diseases Control, Vaccine Preventable Diseases and Immunization, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Josephine Logronio
- Division of Programmes for Diseases Control, Vaccine Preventable Diseases and Immunization, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - James Heffelfinger
- Division of Programmes for Diseases Control, Vaccine Preventable Diseases and Immunization, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Kimberly Fox
- Division of Programmes for Diseases Control, Vaccine Preventable Diseases and Immunization, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Linda De Gouveia
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, African Regional Reference Laboratory For The WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
| | - Anne von Gottberg
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, African Regional Reference Laboratory For The WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
- University of the Witwatersrand, School of Pathology, Faculty of Health Sciences, Johannesburg, South Africa
| | - Mignon Du Plessis
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, African Regional Reference Laboratory For The WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
- University of the Witwatersrand, School of Pathology, Faculty of Health Sciences, Johannesburg, South Africa
| | - Brenda Kwambana-Adams
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, WHO Collaborating Centre for New Vaccines Surveillance and African Regional Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Fajara, Banjul, The Gambia
| | - Martin Antonio
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, WHO Collaborating Centre for New Vaccines Surveillance and African Regional Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Fajara, Banjul, The Gambia
| | - Samaa El Gohary
- Department of Clinical Bacteriology Development, Central Public Health Laboratories, Eastern Mediterranean Region Regional Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Cairo, Egypt
| | - Aya Azmy
- Department of Clinical Bacteriology Development, Central Public Health Laboratories, Eastern Mediterranean Region Regional Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Cairo, Egypt
| | - Asmaa Gamal
- Department of Clinical Bacteriology Development, Central Public Health Laboratories, Eastern Mediterranean Region Regional Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Cairo, Egypt
| | - Elena Voropaeva
- G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Laboratory of Clinical Microbiology and Biotechnology, European Regional Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Moscow, Russian Federation
| | - Ekaterina Egorova
- G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Laboratory of Clinical Microbiology and Biotechnology, European Regional Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Moscow, Russian Federation
| | - Yulia Urban
- G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Laboratory of Clinical Microbiology and Biotechnology, European Regional Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Moscow, Russian Federation
| | - Carolina Duarte
- Instituto Nacional de Salud, Dirección de Redes en Salud Pública, Regional Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Bogotá, D.C., Colombia
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College and Hospital, South-East Asia Regional Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Vellore, Tamil Nadu, India
| | - Samir Saha
- Department of Microbiology, Bangladesh Institute of Child Health and Child Health Research Foundation, South-East Asia Region National Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Dhaka, Bangladesh
| | - Ben Howden
- The Peter Doherty Institute for Infection and Immunity, Microbiological Diagnostic Unit Public Health Laboratory, Western Pacific Region Regional Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Melbourne, Australia
| | - Michelle Sait
- The Peter Doherty Institute for Infection and Immunity, Microbiological Diagnostic Unit Public Health Laboratory, Western Pacific Region Regional Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Melbourne, Australia
| | - Sangoun Jung
- Division of Bacterial Disease, Korea Disease Control and Prevention Agency, Western Pacific Region Regional Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Cheongju-Si, Chungcheongbuk-do, Republic of Korea
| | - Songmee Bae
- Division of Tuberculosis and Bacterial Respiratory Infections, Korea Disease Control and Prevention Agency, Western Pacific Region Regional Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, Cheongju-Si, Chungcheongbuk-do, Republic of Korea
| | - David Litt
- Public Health England, Respiratory and Vaccine Preventable Bacteria Reference Unit, WHO Collaborating Center for Haemophilius and Streptococcus pneumoniae, London, United Kingdom
| | - Shila Seaton
- Public Health England, United Kingdom National External Quality Assessment Services, London, United Kingdom
| | - Mary Slack
- Public Health England, Respiratory and Vaccine Preventable Bacteria Reference Unit, WHO Collaborating Center for Haemophilius and Streptococcus pneumoniae, London, United Kingdom
| | - Sebastien Antoni
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Mahamoudou Ouattara
- Division of Bacterial Diseases, US Centers for Disease Control and Prevention, Global Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, National Center for Immunization and Respiratory Disease, Atlanta, Georgia, USA
| | - Chris Van Beneden
- Division of Bacterial Diseases, US Centers for Disease Control and Prevention, Global Reference Laboratory for the WHO-coordinated Invasive Bacterial Vaccine Preventable Disease Surveillance Network, National Center for Immunization and Respiratory Disease, Atlanta, Georgia, USA
| | - Fatima Serhan
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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Loutfi A, E L Hioui M, Jayche S, Mohammed L, Asmaa A, Lhou A, Dahou B, Omar Touhami Ahami A. Epidemiological, Cytochemical and Bacteriological Profile of Meningitis among Adults and Children in North West of Morocco. Pak J Biol Sci 2021; 23:891-897. [PMID: 32700835 DOI: 10.3923/pjbs.2020.891.897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Meningitis is a medical and public health problem in Morocco, particularly in the North West region. The purpose of present study was to identify the pathogen in pyogenic meningitis and to determine its antibiotic susceptibility pattern Materials and Methods: A total of 247 cases were included in the diagnosis of meningitis on the basis of clinical findings and positive cerebrospinal fluid (CSF). RESULTS The study included 247 cases with a mean cumulative incidence of 4.53 (100,000 Hts) meningitis in all forms during the study period. The sex ratio M/F was 1.71. Maximum numbers of cases were<15 year of age, 139 (56.3%). Bacterial meningeal syndrome was observed in 67.2% of cases. Cerebrospinal fluid (CSF) was cloudy in 57.1% of cases. The average number of GBs was 1074.12 (±2115.63) elements mm-3. Mean glycorrhachia was 0.48 g L-1 (±0.28) and mean protein levels were 1.5 g L-1 (±1.68). The common pathogens identified on CSF culture were coagulase, negative Neisseria meningitidis in 30 (13%) and Streptococcus pneumoniae 6 (2.5%). Overall mortality was 14.9%. CONCLUSION Hence, Meningitis is a real health problem in the province of Kenitra, affecting especially children. Effective involvement of all health personnel and the community fight this epidemic disease.
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Hsieh DY, Lai YR, Lien CY, Chang WN, Huang CC, Cheng BC, Kung CT, Lu CH. Nationwide Population-Based Epidemiological Study for Outcomes of Adjunctive Steroid Therapy in Pediatric Patients with Bacterial Meningitis in Taiwan. Int J Environ Res Public Health 2021; 18:ijerph18126386. [PMID: 34204785 PMCID: PMC8296207 DOI: 10.3390/ijerph18126386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
Although corticosteroids can serve as an effective anti-inflammatory adjuvant therapy, the role of adjunctive steroid therapy in pediatric bacterial meningitis in Taiwan remains under-investigated. Cases of acute bacterial meningitis, aged between 1 month and 20 years, were divided into a steroid group (empirical antibiotics with adjunctive steroid therapy) and a non-steroid group (empirical antibiotics only). Data were identified from the annual hospitalization discharge claims of the National Health Insurance Research Database using the International Classification of Diseases, Ninth Revision codes. Of the 8083 episodes enrolled in this study, 26% (2122/8083) and 74% (5961/8083) were divided into the steroid and non-steroid groups, respectively. The fatality rates were 7.9% in the steroid group and 1.7% in the non-steroid group during hospitalization (p < 0.0001). In the steroid and non-steroid groups, the median length of hospital stay was 13 and 6 days, respectively (p < 0.0001). Medical costs (median (interquartile range)) of hospitalization were 77,941 (26,647–237,540) and 26,653 (14,287–53,421) New Taiwan dollars in the steroid and non-steroid groups, respectively (p < 0.0001). The steroid group had a more fulminant course at baseline, a higher fatality rate, length of hospital stay, and medical cost of hospitalization. Therefore, the beneficial effects of the adjunctive use of corticosteroids in pediatric bacterial meningitis are inconclusive, and additional prospective multicenter investigations are required to clarify this issue.
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Affiliation(s)
- Dong-Yi Hsieh
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Yun-Ru Lai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Chia-Yi Lien
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Wen-Neng Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Chih-Cheng Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Ben-Chung Cheng
- Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan;
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan;
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen 361000, China
- Correspondence:
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Obiero CW, Mturi N, Mwarumba S, Ngari M, Newton CR, van Hensbroek MB, Berkley JA. Clinical features of bacterial meningitis among hospitalised children in Kenya. BMC Med 2021; 19:122. [PMID: 34082778 PMCID: PMC8176744 DOI: 10.1186/s12916-021-01998-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/29/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diagnosing bacterial meningitis is essential to optimise the type and duration of antimicrobial therapy to limit mortality and sequelae. In sub-Saharan Africa, many public hospitals lack laboratory capacity, relying on clinical features to empirically treat or not treat meningitis. We investigated whether clinical features of bacterial meningitis identified prior to the introduction of conjugate vaccines still discriminate meningitis in children aged ≥60 days. METHODS We conducted a retrospective cohort study to validate seven clinical features identified in 2002 (KCH-2002): bulging fontanel, neck stiffness, cyanosis, seizures outside the febrile convulsion age range, focal seizures, impaired consciousness, or fever without malaria parasitaemia and Integrated Management of Childhood Illness (IMCI) signs: neck stiffness, lethargy, impaired consciousness or seizures, and assessed at admission in discriminating bacterial meningitis after the introduction of conjugate vaccines. Children aged ≥60 days hospitalised between 2012 and 2016 at Kilifi County Hospital were included in this analysis. Meningitis was defined as positive cerebrospinal fluid (CSF) culture, organism observed on CSF microscopy, positive CSF antigen test, leukocytes ≥50/μL, or CSF to blood glucose ratio <0.1. RESULTS Among 12,837 admissions, 98 (0.8%) had meningitis. The presence of KCH-2002 signs had a sensitivity of 86% (95% CI 77-92) and specificity of 38% (95% CI 37-38). Exclusion of 'fever without malaria parasitaemia' reduced sensitivity to 58% (95% CI 48-68) and increased specificity to 80% (95% CI 79-80). IMCI signs had a sensitivity of 80% (95% CI 70-87) and specificity of 62% (95% CI 61-63). CONCLUSIONS A lower prevalence of bacterial meningitis and less typical signs than in 2002 meant the lower performance of KCH-2002 signs. Clinicians and policymakers should be aware of the number of lumbar punctures (LPs) or empirical treatments needed for each case of meningitis. Establishing basic capacity for CSF analysis is essential to exclude bacterial meningitis in children with potential signs.
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Affiliation(s)
- Christina W Obiero
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya.
- Department of Global Health, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands.
| | - Neema Mturi
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya
| | - Salim Mwarumba
- Department of Microbiology, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Moses Ngari
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Charles R Newton
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - James A Berkley
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Burstein B, Sabhaney V, Bone JN, Doan Q, Mansouri FF, Meckler GD. Prevalence of Bacterial Meningitis Among Febrile Infants Aged 29-60 Days With Positive Urinalysis Results: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e214544. [PMID: 33978724 PMCID: PMC8116985 DOI: 10.1001/jamanetworkopen.2021.4544] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Fever in the first months of life remains one of the most common pediatric problems. Urinary tract infections are the most frequent serious bacterial infections in this population. All published guidelines and quality initiatives for febrile young infants recommend lumbar puncture (LP) and cerebrospinal fluid (CSF) testing on the basis of a positive urinalysis result to exclude bacterial meningitis as a cause. For well infants older than 28 days with an abnormal urinalysis result, LP remains controversial. OBJECTIVE To assess the prevalence of bacterial meningitis among febrile infants 29 to 60 days of age with a positive urinalysis result to evaluate whether LP is routinely required. DATA SOURCES MEDLINE and Embase were searched for articles published from January 1, 2000, to July 25, 2018, with deliberate limitation to recent studies. Before analysis, the search was repeated (October 6, 2019) to ensure that new studies were included. STUDY SELECTION Studies that reported on healthy, full-term, well-appearing febrile infants 29 to 60 days of age for whom patient-level data could be ascertained for urinalysis results and meningitis status were included. DATA EXTRACTION AND SYNTHESIS Data were extracted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and used the Newcastle-Ottawa Scale to assess bias. Pooled prevalences and odds ratios (ORs) were estimated using random-effect models. MAIN OUTCOMES AND MEASURES The primary outcome was the prevalence of culture-proven bacterial meningitis among infants with positive urinalysis results. The secondary outcome was the prevalence of bacterial meningitis, defined by CSF testing or suggestive history at clinical follow-up. RESULTS The parent search yielded 3227 records; 48 studies were included (17 distinct data sets of 25 374 infants). The prevalence of culture-proven meningitis was 0.44% (95% CI, 0.25%-0.78%) among 2703 infants with positive urinalysis results compared with 0.50% (95% CI, 0.33%-0.76%) among 10 032 infants with negative urinalysis results (OR, 0.74; 95% CI, 0.39-1.38). The prevalence of bacterial meningitis was 0.25% (95% CI, 0.14%-0.45%) among 4737 infants with meningitis status ascertained by CSF testing or clinical follow-up and 0.28% (95% CI, 0.21%-0.36%) among 20 637 infants with positive and negative urinalysis results (OR, 0.89; 95% CI, 0.48-1.68). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, the prevalence of bacterial meningitis in well-appearing febrile infants 29 to 60 days of age with positive urinalysis results ranged from 0.25% to 0.44% and was not higher than that in infants with negative urinalysis results. These results suggest that for these infants, the decision to use LP should not be guided by urinalysis results alone.
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Affiliation(s)
- Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Vikram Sabhaney
- Division of Pediatric Emergency Medicine, Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey N. Bone
- Department Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fahad F. Mansouri
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Garth D. Meckler
- Division of Pediatric Emergency Medicine, Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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Rahman AE, Hossain AT, Zaman SB, Salim N, K C A, Day LT, Ameen S, Ruysen H, Kija E, Peven K, Tahsina T, Ahmed A, Rahman QSU, Khan J, Kong S, Campbell H, Hailegebriel TD, Ram PK, Qazi SA, El Arifeen S, Lawn JE. Antibiotic use for inpatient newborn care with suspected infection: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:229. [PMID: 33765948 PMCID: PMC7995687 DOI: 10.1186/s12884-020-03424-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND An estimated 30 million neonates require inpatient care annually, many with life-threatening infections. Appropriate antibiotic management is crucial, yet there is no routine measurement of coverage. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aimed to validate maternal and newborn indicators to inform measurement of coverage and quality of care. This paper reports validation of reported antibiotic coverage by exit survey of mothers for hospitalized newborns with clinically-defined infections, including sepsis, meningitis, and pneumonia. METHODS EN-BIRTH study was conducted in five hospitals in Bangladesh, Nepal, and Tanzania (July 2017-July 2018). Neonates were included based on case definitions to focus on term/near-term, clinically-defined infection syndromes (sepsis, meningitis, and pneumonia), excluding major congenital abnormalities. Clinical management was abstracted from hospital inpatient case notes (verification) which was considered as the gold standard against which to validate accuracy of women's report. Exit surveys were conducted using questions similar to The Demographic and Health Surveys (DHS) approach for coverage of childhood pneumonia treatment. We compared survey-report to case note verified, pooled across the five sites using random effects meta-analysis. RESULTS A total of 1015 inpatient neonates admitted in the five hospitals met inclusion criteria with clinically-defined infection syndromes. According to case note verification, 96.7% received an injectable antibiotic, although only 14.5% of them received the recommended course of at least 7 days. Among women surveyed (n = 910), 98.8% (95% CI: 97.8-99.5%) correctly reported their baby was admitted to a neonatal ward. Only 47.1% (30.1-64.5%) reported their baby's diagnosis in terms of sepsis, meningitis, or pneumonia. Around three-quarters of women reported their baby received an injection whilst in hospital, but 12.3% reported the correct antibiotic name. Only 10.6% of the babies had a blood culture and less than 1% had a lumbar puncture. CONCLUSIONS Women's report during exit survey consistently underestimated the denominator (reporting the baby had an infection), and even more so the numerator (reporting known injectable antibiotics). Admission to the neonatal ward was accurately reported and may have potential as a contact point indicator for use in household surveys, similar to institutional births. Strengthening capacity and use of laboratory diagnostics including blood culture are essential to promote appropriate use of antibiotics. To track quality of neonatal infection management, we recommend using inpatient records to measure specifics, requiring more research on standardised inpatient records.
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Affiliation(s)
- Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Nahya Salim
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
| | - Ashish K C
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise T Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Edward Kija
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
| | - Kimberly Peven
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Jasmin Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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Zhang D, Xu S, Wang Y, Zhu G. The Potentials of Melatonin in the Prevention and Treatment of Bacterial Meningitis Disease. Molecules 2021; 26:1419. [PMID: 33808027 PMCID: PMC7961363 DOI: 10.3390/molecules26051419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 02/08/2023] Open
Abstract
Bacterial meningitis (BM) is an acute infectious central nervous system (CNS) disease worldwide, occurring with 50% of the survivors left with a long-term serious sequela. Acute bacterial meningitis is more prevalent in resource-poor than resource-rich areas. The pathogenesis of BM involves complex mechanisms that are related to bacterial survival and multiplication in the bloodstream, increased permeability of blood-brain barrier (BBB), oxidative stress, and excessive inflammatory response in CNS. Considering drug-resistant bacteria increases the difficulty of meningitis treatment and the vaccine also has been limited to several serotypes, and the morbidity rate of BM still is very high. With recent development in neurology, there is promising progress for drug supplements of effectively preventing and treating BM. Several in vivo and in vitro studies have elaborated on understanding the significant mechanism of melatonin on BM. Melatonin is mainly secreted in the pineal gland and can cross the BBB. Melatonin and its metabolite have been reported as effective antioxidants and anti-inflammation, which are potentially useful as prevention and treatment therapy of BM. In bacterial meningitis, melatonin can play multiple protection effects in BM through various mechanisms, including immune response, antibacterial ability, the protection of BBB integrity, free radical scavenging, anti-inflammation, signaling pathways, and gut microbiome. This manuscript summarizes the major neuroprotective mechanisms of melatonin and explores the potential prevention and treatment approaches aimed at reducing morbidity and alleviating nerve injury of BM.
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Affiliation(s)
- Dong Zhang
- College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, China; (D.Z.); (S.X.); (Y.W.)
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, China
| | - Shu Xu
- College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, China; (D.Z.); (S.X.); (Y.W.)
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, China
| | - Yiting Wang
- College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, China; (D.Z.); (S.X.); (Y.W.)
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, China
| | - Guoqiang Zhu
- College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, China; (D.Z.); (S.X.); (Y.W.)
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, China
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